In a healthcare landscape squeezed by reimbursement pressures and economic challenges, complex spine and revision surgery are becoming harder to deliver sustainably.
Two spine surgeons discuss why these changes are happening.
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: When you watch a larger group expand into your market, what’s your honest first reaction: threat, opportunity, or noise? Why?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CST Tuesday, April 7.
Editor’s note: Responses were lightly edited for clarity.
Question: Which spine cases are becoming harder to deliver sustainably, and what’s driving that change?
Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: Complex revisions and adult deformity corrections are becoming economically challenging despite being exactly the cases where specialized surgical expertise matters most. These operations require significant OR time, expensive instrumentation, intensive post-operative care, and carry complication risk even with excellent technique — all while reimbursement has stagnated. The gap between resources consumed and payment received grows, especially when complications occur. This creates a troubling reality: patients who most need specialized care may struggle to access it because providing that care becomes financially unsustainable for practices and hospitals. We’re also seeing comprehensive conservative care programs struggle when PT reimbursement is inadequate and patients require months of multimodal treatment. The drivers are systemic: reimbursement pressure, shift to value-based care without adequate risk adjustment for complexity, and administrative costs of prior authorization. The irony is profound: we’re making it harder to deliver care requiring the most expertise while the system still accommodates—and sometimes incentivizes — simpler procedures. This isn’t what any surgeon wants; it’s a system-level problem requiring fundamental payment reform so physicians committed to helping complex patients can continue doing so sustainably.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): From my perspective, sustainability in healthcare is acknowledged and accomplished with long-term outcomes. Well recognized and most scrutinized at the appeals level are multisegmented and transcavitary fusion procedures. Prolonged surgical time, hospital admissions and stay, inadequate nervous system decompression and long-term outcome attainment and patient satisfaction. Decoupling the staggering cost impairment to patient and system alike portends a marginal surgical result when diagnosis and treatment is better managed in a more conservative mindset.
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