As reimbursements decline, spine surgeons are faced with weighing the needs of their patients and the sustainability of their practice.
While patient needs remain at the forefront, the environment around clinical choices have been affected by shifts in Medicare and payer reimbursement.
Three surgeons discuss their approaches.
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 question: What policy change would most improve access to appropriate spine care in your market?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CDT Tuesday, March 3.
Editor’s note: Responses were lightly edited for clarity.
Question: How are reimbursement trends influencing which spine procedures you’re willing (or unwilling) to offer?
Brian McHugh, MD. McHugh Neurosurgery (West Islip, N.Y.): My clinical decisions are driven by what is appropriate for the specific patient at a specific time. However, unfortunately, reimbursement trends do shape the environment around those decisions. Commercial payments increasingly tied to Medicare benchmarks have not kept pace with the rising costs of staffing, hospital infrastructure, and complex care.
High-acuity cases such as deformity corrections and revision spine surgery require time, resources, and experienced teams. When reimbursement does not reflect that complexity, it becomes harder for highly specialized independent practices to sustain those services. The issue is not compensation. It is whether reimbursement models allow independent surgeons to continue offering the full spectrum of spine surgery patients rely on.
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: Reimbursement trends create difficult tension between what patients need and what’s economically sustainable. I’m increasingly concerned about complex revisions or procedures requiring significant OR time when reimbursement hasn’t kept pace with costs, not because profitability drives my decisions, but because hospitals can’t sustain these operations long-term.
This means patients needing specialized care may struggle to access it. The economics also undermine comprehensive conservative care that most spine surgeons would prefer patients receive: cognitive work and care coordination are poorly reimbursed compared to procedures. A surgeon committed to appropriate patient selection faces an uncomfortable reality: we can spend 30 minutes explaining why someone doesn’t need surgery and coordinating alternatives — which barely covers practice costs — or maintain efficiency through shorter visits and procedural volume.
Most surgeons I know want to do the former; the system rewards the latter. Until reimbursement aligns with best practices, even well-intentioned physicians face pressure that doesn’t serve patients well.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): As an employed specialty surgeon, patient and procedural selection is based on discerned symptoms, severity of those individuals and correlates, coupled with appropriate surgical application. Decision is clearly based on the patient’s needs. Adjudicating and prearrangement of surgery follows that dictum, and biased influence is not a choice nor methodology.
