CMS changes that spine surgeons want to see

Alan Condon -   Print  |
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While CMS' decision last year to gradually phase out the inpatient-only list has been widely welcomed by the spine community, other regulatory changes related to reduced reimbursement and increased prior authorization requirements have not.

Three spine surgeons have proposed Medicare changes that they say would significantly improve spine care.

Issada Thongtrangan, MD. Microspine (Phoenix): The only hope I have is that the CMS will not keep trimming the professional fee. As we all know, advanced technology is not without cost, but it is for the patients' outcomes. It is sad to see that CMS looks at the surgical technique as one-all-be-all. For example, the open lumbar fusion is not equal to minimally invasive fusion or endoscopic fusion in terms of the work and instruments each surgeon uses.

Michael Gordon, MD. Hoag Orthopedic Institute (Orange County, Calif.): Payment should be risk-adjusted and site of care should be irrelevant, so surgeons are paid properly for risk and expertise and to avoid gaming the system on where to do surgery and how long to keep patients in the hospital.

1. [CMS] needs to pay more. Spine surgeons have seen a steady decline in reimbursement.

2. Coding for outpatient anterior/posterior lumbar fusion is not up to date.

3. The bundled payment system is not good for spine. It needs modification.

If the benefit is for patients, I would create accessible, transparent, risk-adjusted outcomes data on each surgeon and facility, so they can compare apples to apples when choosing.

Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): Spine surgery outcomes have gotten significantly better in recent years, especially with the introduction of such innovations as minimally invasive spine surgery, disc replacement and navigated and robotic surgery. Despite that, CMS reimbursement per procedure has been going down every year for as long as I can remember.

Spine care would greatly benefit if CMS can start paying spine surgeons appropriately (commensurate with increasing practice costs, inflation and increasing regulatory burdens) for the work done. In my 11-year career in spine surgery I have seen my Medicare reimbursement for most spine operations decrease every year, even though I can now do them better with better patient outcomes. I am not aware of any other industry where a professional gets paid less for doing the same work as their experience and quality of work improves over the years.

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