Patient-reported outcomes were once a research exercise, the kind of data a spine program collected for a registry or a journal submission and rarely looked at again. That era is over. PROMs now sit directly on the line between a spine practice’s revenue, its referrals and its ability to keep the contracts it has.
The shift is not rhetorical. Three forces have turned outcome measurement into a business requirement, and the practices treating it as optional are exposing themselves in ways that will surface in their payer mix and their case flow.
Federal models now require the data
The clearest driver is Medicare. Spinal fusion is one of five surgical episodes inside the Transforming Episode Accountability Model, the mandatory bundle that launched Jan. 1 and holds selected hospitals accountable for the cost and quality of fusion episodes. The model leans heavily on capturing patient-reported outcome measures, which means the hospital partners that spine surgeons depend on are now obligated to produce that data.
The pressure moves to the individual surgeon next. Beginning Jan. 1, 2027, the Ambulatory Specialty Model will score orthopedic surgeons, neurosurgeons and pain specialists treating low-back-pain patients on quality, cost and other categories, benchmarked against regional peers. Quality scoring runs through outcomes, and the adjustment attaches to the clinician.
Payers are pricing the outpatient shift
The second driver is the migration of fusion into ASCs. Payers and hospital partners increasingly want proof that a lower-cost outpatient case delivers the same result as the inpatient version.
That proof does not exist without baseline and follow-up scores. A program not already capturing Oswestry Disability Index or PROMIS data before surgery and at defined intervals afterward has no way to demonstrate its outcomes when a payer or a referring system asks, a gap that can cost a group referrals and negotiating leverage. Outcome data is becoming the price of admission to the contracts that matter.
Philip Louie, MD, a spine surgeon and medical director of research and academics at Virginia Mason Franciscan Health in Tacoma, Wash., warned Becker’s that value-based care can slide into “a label for cost reduction” when it is not anchored to real measurement. Cutting implant spend or narrowing a network lowers cost without improving anything about function or recovery. PROMs are what separate the two.
The tools already exist
Spine has no excuse of immaturity. The specialty has validated, widely used instruments: the Oswestry Disability Index for lumbar disease, the Neck Disability Index for cervical cases, visual analog pain scales and the PROMIS system, with more than 20 recognized measures tracking function and recovery after spinal surgery.
The harder problem is discipline, not availability. At Cleveland Clinic, an early builder of outcomes infrastructure, the team found it was collecting too many measures at too many time points before paring down to a standardized set gathered at key moments in the patient journey. A lean, consistent program beats an ambitious one that no one can use.
From collecting to using
The leaders furthest ahead treat PROMs as a clinical and competitive tool, not a compliance chore. Kevin Bozic, MD, chair of surgery and perioperative care at Dell Medical School at the University of Texas at Austin, rejects the passive framing entirely.
“We don’t collect lab values and imaging. We use them,” he told Becker’s, arguing outcomes should guide decisions at the point of care and help surgeons decide who should have surgery and when.
That reframing carries a market consequence. Eric Makhni, MD, a sports medicine orthopedic surgeon at Detroit-based Henry Ford Health, put the business logic simply: a practice that wants to claim it delivers high-value care has to prove it, and “PROMs is the way to do that,” he said. Groups that can document their results will win the payer conversations and the referral relationships that groups without data cannot.
The infrastructure question is no longer whether to build it, but whether it will be ready when a hospital partner, a payer or a federal model demands it. Surgeons who wait for the payment model to force their hand will be building from zero while competitors present years of benchmarked results.
Vijay Yanamadala, MD, a spinal neurosurgeon with Hartford (Conn.) HealthCare, described the moment as “an awkward adolescence” for value-based spine care, in which most surgeons are still paid for procedures while the infrastructure catches up. The surgeons positioned to thrive in five years are the ones building outcome-driven practices now. For the rest, patient-reported outcomes will arrive as a requirement they were not ready to meet.
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.