The Lown Institute reported that spine surgeries deemed “unnecessary” have cost Medicare billions of dollars but the findings don’t show the full picture, some surgeons say.
Two spine surgeons share their perspectives.
Note: Responses were lightly edited.
Question: “Unnecessary” spine surgeries have cost Medicare almost $2B over three years, according to the Lown Institute. What’s needed from physicians, devicemakers and policymakers to address this?
Fred Naraghi, MD. Sky Lakes Health System (Klamath Falls, Ore.): While the Lown Institute raises valid questions about value in spine care, its conclusions risk oversimplifying the nuanced decisions that we as spine surgeons face daily. Many procedures labeled “unnecessary” are performed for patients who have failed every conservative option and are desperate for relief.
The real solution may require collaboration, refining indications, strengthening shared decision-making, tracking outcomes through national registries, and payment models that reward outcomes and not just volume.
Device makers should focus on evidence, not marketing, and policymakers should encourage quality without fueling insurance denials that already delay care egregiously. A fairer RVU model would reward outcomes and patient satisfaction alongside volume and technical skill.
Of course, such a balance between payers, policymakers, and surgeons may only happen when we all achieve spine-care nirvana!
David Skaggs, MD. Cedars-Sinai (Los Angeles): While this analysis is well-intentioned, it is fundamentally limited by its methodology. Coding data cannot capture the complexity of spine pathology or the clinical reasoning that drives surgical decision-making. Labeling operations as “unnecessary” based on administrative codes oversimplifies a nuanced process that weighs anatomy, function, pain, and patient goals. That said, perception matters — and the spine community should confront concerns about overuse head-on, not dismiss them.
At Cedars-Sinai Spine, we’ve built structural safeguards into our process. Every elective case undergoes rigorous peer review by both orthopedic and neurosurgical spine faculty before proceeding to the operating room. These 6:30 a.m. conferences are demanding and uncompensated, but they often lead to real changes: modifying the planned procedure, delaying surgery for further conservative care, or determining that no surgery is warranted. Peer scrutiny isn’t always comfortable, but it’s essential. Our aim isn’t to defend every spine surgery — it’s to make sure each one stands up to scrutiny.
