Eliminating prior authorization, accelerating Medicare’s inpatient-only phaseout and shifting toward outcomes-based reimbursement are among the top policy changes spine surgeons say would improve access and reimbursement in spine care.
Five spine surgeons recently connected with Becker’s to share the single reform they would prioritize if they had one day to reshape healthcare policy.
Editor’s note: Responses were lightly edited for clarity and length
Question: If you had full control of healthcare policy for one day, what’s the first change you’d make to improve spine care access or reimbursement?
Jason Cuéllar, MD, PhD. Spine Arthroplasty Surgeon at Cuéllar Spine (Palm Beach, Fla.): Spine access is rife with problems related to insurance coverage, and it’s only getting worse. If I could make one change, it would be to abolish the prior authorization system. This practice wastes more time and creates more barriers to care than any other. If a competent spine surgeon completes the appropriate workup and develops a surgical plan with their patient, insurers shouldn’t have the right to intervene, delay or deny that care.
Deptee Jain, MD. Orthopedic Spine Surgeon at the Center for Bone and Joint Surgery of the Palm Beaches (Wellington, Fla.): I’d accelerate Medicare’s phase-out of the Inpatient-Only list, which hasn’t kept up with surgical innovation. Complex procedures like lumbar fusions can now be done safely in ASCs or outpatient hospitals, where patients recover faster and have a better experience. But if a procedure remains on the list, Medicare won’t reimburse it outside an inpatient setting, driving up costs unnecessarily. CMS has proposed eliminating the list starting in 2026. Updating it to reflect modern practice would expand access, improve efficiency and lower costs.
Nitin Khanna, MD. Surgeon at Spine Care Specialists (Munster, Ind.): I’d focus on leveling the playing field for providers. That starts with lifting the ban on physician-owned hospitals and repealing Stark law. Medicare physician payments also need to be raised — current professional fees are just 10% of what’s reasonable, and doubling them would improve access for seniors. Insurers should be held liable for delays caused by prior authorization, with real penalties. Finally, reimbursement should reflect the high quality of care at freestanding ASCs, which consistently deliver safe outcomes at lower costs. Cost transparency and physician complication rates should be mandatory so patients can make informed choices.
Philip Louie, MD. Spine Surgeon and Medical Director of Research and Academics at Virginia Mason Franciscan Health (Seattle): I’d shift reimbursement away from volume-based cuts and toward risk-stratified, outcomes-driven incentives. Right now, complexity is penalized while volume is rewarded. Surgeons who take on high-risk patients or invest in safer, cost-saving innovations see no benefit under the current model. A surgeon using multidisciplinary pathways for a complex Medicare patient may be paid the same as for a simple case, despite the added work and improved outcomes. Smarter risk-adjusted models should reward results like pain relief, restored function and fewer complications, while protecting access for vulnerable populations and aligning payers and providers around meaningful outcomes.
Jordan Kump, MD. Orthopedic Spine Surgeon of Orthopedic Centers of Colorado (Denver): I’d start with two reforms: implementing site-neutral payments and overhauling prior authorization. Hospitals are reimbursed at higher rates than ASCs or independent practices for the same procedures, driving consolidation and limiting choice. Site neutrality would allow patients to get care in the most appropriate setting without financial distortions. At the same time, prior authorization is one of the biggest barriers to timely care. Even when evidence supports an intervention, patients face delays that worsen their condition. Standardizing criteria and enforcing rapid turnaround times would reduce waste and administrative burden. Together, these changes would make spine care more patient-centered and cost-effective.
