Spine surgeons limiting Medicare patients due to cost-cutting: What needs to change?

Alan Condon -  

Ahead of Medicare's regulatory and reimbursement proposals for 2023, three spine surgeons suggested updates that would expand access to care and reduce the economic burdens that many independent providers face today.

Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. Becker's invites all spine surgeon and specialist responses.

Next week's question: How do you anticipate spine surgery will develop in the era of value-based care? What payer trends are you anticipating in your market?

Please send responses to Alan Condon at acondon@beckershealthcare.com by 5 p.m. CDT Wednesday, July 6.

Editor's note: Responses were lightly edited for clarity and length.

Question: If you could make one Medicare change overnight, what would it be and why?

Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: Firstly, there must be a [cost-of-living adjustment] increase for CMS payments. This has not happened for almost two decades. Next, sunsetting mandatory Medicare Advantage plans and letting people keep their original Medicare plans plus a supplement must be preserved. By all means keep them, but do not allow insurers to falsely advertise their equivalency of access and quality to straight Medicare.  Thirdly, do not allow insurers to set their benchmarks to Medicare. There must be accountability from insurers that falsely tie their rates to Medicare, and they should be mandated to consider the usual and customary fees rather than Medicare multiples. Lastly, run an audit of all private insurers, using their own software, in order to find the "missing billions" and reasons why despite lowering physician payments, healthcare costs continue to rise.

Nick Jain, MD. DISC Sports & Spine Center (Newport Beach, Calif.): While prior authorization for ACDF is an obvious target due to the increased authorization process burden and delay in care, I think the decreasing CMS fee will prove to be the most detrimental recent change to patient care. As reimbursement costs decrease while staffing costs and inflation soar to all-time highs, physicians will be forced to spend less time with patients to make ends meet, resulting in shorter face-to-face visits with an increasingly sicker and older patient population who require our full attention and dedication. This will only lead to the further degradation of the physician-patient relationship and, for that reason, I would eliminate the recent cuts to the CMS fee schedule.

Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): The biggest issue with Medicare is the ever-increasing regulatory and documentation burden. It is getting more difficult and requires more practice resources to stay compliant with all of their regulations, most of which do not actually benefit patient care. For example, the recent development of requiring prior authorization for cervical fusion surgery made it much more difficult to get those operations done in a timely manner.  

A close second issue is declining reimbursements. Medicare keeps cutting reimbursements for all physicians, but even more so for surgical procedures, including spine surgery. With the current levels of inflation, the costs of running a medical practice are going up rapidly, making it very difficult for a spine practice to stay financially solvent on Medicare reimbursements.  

These two issues are currently causing more spine surgeons to either limit their Medicare patient panels or stop taking Medicare all together. It will decrease access to care for Medicare beneficiaries.

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