For spine surgeons, declining reimbursement is no longer just a financial concern. It is increasingly shaping which patients they can see, which procedures they can offer and how much time they can spend delivering care.
From shrinking independent practices and reduced patient access to the growing financial risks of complex procedures, spine surgeons told Becker’s that reimbursement pressures have already crossed into patient care. Several warned that further cuts could force physicians to make increasingly difficult decisions about which services remain financially sustainable.
CMS’ proposed 2027 Medicare Physician Fee Schedule, released July 14, would cut the conversion factor 1.68% to $32.84 from $33.40 for physicians outside advanced alternative payment models. The decline largely reflects the expiration of a one-year, 2.5% payment increase Congress provided for 2026.
Separately, CMS’ specialty impact analysis estimates that relative value unit changes would reduce orthopedic surgery payments by another 7%. The final rule typically publishes around Nov. 1.
Six spine surgeons shared where they believe the breaking point lies, what gives first and why patients may ultimately bear the greatest cost.
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: Minimally invasive spine surgery keeps expanding, but not every smaller operation is necessarily a better one. Where do you think MIS delivers its clearest advantage, and where is the enthusiasm getting ahead of the evidence?
Please send responses to Sophie Eydis at seydis@beckershealthcare.com by 5 p.m. Central time Sunday, Nov. 1.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: At what point do reimbursement cuts stop being a business problem and start changing the care you can realistically provide? What gives first?
Joel Beckett, MD. Neurosurgeon at Beckett NeuroSpine (Beverly Hills, Calif.): I think we have already crossed that threshold. Reimbursement pressure is contributing to the consolidation of independent practices and smaller groups into larger health systems, where negotiating leverage and site-dependent payment rates can make the same care more financially sustainable simply because of the institution providing it.
That changes more than the business of medicine. It changes where patients receive care, which physicians they can access and how that care is delivered. The independent practitioner has long been a foundation of American medicine, and sustaining that model is becoming increasingly difficult.
What gives first is often time with the patient and continuity of care. Practices trying to remain in network under inadequate reimbursement may shorten visits, reduce follow-up availability or shift more care to advanced practice providers. Others move out of network, creating a different set of access and affordability challenges for patients.
The concern is not whether one practice model is inherently better than another. It is whether reimbursement allows physicians to provide the time, access and follow-through patients need. When those decisions are driven primarily by financial survival, reimbursement cuts have already become a patient-care problem.
Krishna Satyan, MD. Neurosurgeon at Dallas Neurosurgical & Spine (Dallas): This is already happening. Some surgeons have already stopped performing certain procedures, such as carpal tunnel release and ulnar nerve release, because of reimbursement. Personally, this is not an issue for me at this time.
But as I look to the future and reimbursements keep decreasing, it may become a more serious concern. Just as we discuss the risk-benefit ratio of a procedure with patients, there is a risk-benefit ratio for the surgeon performing it. When the cost of caring for a patient, including the liability exposure of treating them, exceeds what that care reimburses, certain procedures will no longer be sustainable to offer.
What gives first are the procedures where that math breaks down soonest: lower-reimbursed, higher-risk cases that a practice cannot absorb at a loss.
Issada Thongtrangan, MD. Endoscopic and Minimally Invasive Spine Surgeon at MicroSpine (Scottsdale, Ariz.): It stops being just a business issue when cuts affect the ability to provide safe, timely care, not simply profitability.
What gives first is usually staff, clinic time and investment in technology. Then practices begin avoiding the most complex, high-risk revision, deformity and poorly reimbursed cases. Eventually, patients face longer waits, fewer local options and less access to experienced spine surgeons.
The concern is not that every dollar cut worsens care. It is that repeated, indiscriminate cuts force decisions based on what is financially sustainable rather than solely on what the patient needs.
David Weiner, MD. Assistant Professor of Orthopedic Surgery at MedStar Health (Columbia, Md.): Reimbursement becomes a care problem when the practice can no longer support the people and time that good care requires. The first things to erode are often access, care coordination and the ability to have a thoughtful conversation with a complex patient; those losses may be less visible than a canceled operation, but patients feel them. If the only way to remain viable is to increase volume indefinitely, the system is asking clinicians to trade away the very judgment it depends on.
Nolan Wessell, MD. Assistant Professor of Orthopedic Surgery at University of Colorado Anschutz School of Medicine (Aurora, Colo.): We’re already past the point where cuts to reimbursement impact the care we provide. Within orthopedics, inflation-adjusted reimbursement has seen a roughly 30% decline over the past 25 years. Patients and politicians need to understand that professional reimbursements don’t equate to money in your doctor’s pocket. Overhead costs, such as office space, equipment, supplies, staff salaries/benefits, can exceed 50% to 60% in many cases. Private practices all over the country have closed or been acquired by private equity or large health systems.
Without a doubt, this has led to less personalized care and higher costs through increased ordering of tests and higher facility fees. Patients with lower-paying insurance are facing massive limitations in access to care, often when they need it the most. The potential of additional CMS cuts early in 2027 may be the nail in the coffin for private practices that have survived this long. Even legislation aimed at limiting private equity’s involvement in healthcare is short-sighted, as such proposals do absolutely nothing to change the potential viability of those practices facing closure or sale.
Christian Zimmerman, MD. Spinal Neurosurgeon at St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): As a multidecade employee of a large healthcare institution, many business concerns and logistical predicaments have been assuredly managed by the corporate home office and capable managerial staff. Both the mundanity and the arduous task-resolution management of the employee model allow for the preferred practice of medicine to be more direct and focal. The unfortunate business stature of healthcare delivery remains effectuated, absolute and enduringly inseparable in our social order barring further economic or political cataclysm.
Acuminate spinal practices purposed in the foray of compounded and the intricate, require its dutiful attention. The entirety of healthcare has sustained economizing measures, both restricting and directing many physician practices in one direction. Furthering, these trends are immediate in their impact and the permanence in healthcare’s existence. Coexistence is a determinative choice and one of the solutions. The other being a concession or refusal to administer care to certain denizens of our society.
The decision to modify or withhold certain aspects of surgical care is not a modern phenomenon, but rather a choice best suited by individual circumstance. Ensuing consequence and further systemic burden are the results of cherry-picking one’s patients, and deference summates additional burdens to those who remain.
Even though this system has its current limitations of specialty care, the current arrangement of delay in care worsens over time. The trickledown effect of stratified exclusionary care and its burden on those systems that accommodate are already present.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
