For generations, physicians have focused on the next patient and left policy and the business of medicine to others. Michael Verdon, DO, a neurosurgeon in Dayton, Ohio, believes that model is approaching a turning point. After watching threatened Medicare cuts get pushed out to the next congressional budget fight, last year they stopped getting pushed.
“Every year there was going to be a cut, and it never happened. They just kept kicking, and they’ve stopped doing that,” said Dr. Verdon. “A lot of people like me aren’t really, quote unquote, ‘worried.’ … I think we should be worried.”
With CMS’ final 2027 physician fee schedule expected in early November and the mandatory Ambulatory Specialty Model set to launch Jan. 1, 2027, Dr. Verdon said spine, orthopedic and ASC physicians who wait for policy to land on their desks will spend the next year reacting to it.
“It’s much more effective to be proactive than reactive,” he said.
The rules are public — if you read them
Dr. Verdon said he had never read a piece of legislation until the COVID-19 pandemic until programs like the Paycheck Protection Program forced him to. The lesson stuck.
“The government tells everybody what they’re doing; just no one bothers to look,” he said.
One change he’s tracking: a CMS proposal in the 2027 physician fee schedule that would cut payment by 50% for the lower-valued service when a physician bills an evaluation and management visit and a procedure on the same day. For physicians who don’t perform in-office procedures, it’s a nonissue. For those who do — Dr. Verdon performs diagnostic injections — it changes the math. He already tells patients who need an injection that it will happen at a separate visit.
The response, he said, is knowing your reimbursement well enough to bill the highest-value code for each encounter, then building workflows around it.
“They’re going to bundle stuff, and you have to figure out how to not get caught in the bundle,” he said.
ASM is coming, whether physicians believe it or not
The Ambulatory Specialty Model ties Medicare Part B payment for specialists who treat low back pain — anesthesiology, pain management, interventional pain management, neurosurgery, orthopedic surgery, and physical medicine and rehabilitation — to their cost and quality performance against peers. It runs five performance years, through Dec. 31, 2031.
Many physicians still don’t think it will happen, Dr. Verdon said. “I’m like, it’s happening.”
He is meeting this week with a group that has seven physicians on the ASM list to model what the model could mean for them financially.
No one knows exactly how the numbers will shake out, he said, but the measures are known. Physicians should start collecting that data now so they can defend themselves in an audit. Otherwise, he expects more retroactive denials and delays — on top of prior authorization burdens that aren’t going away.
Two outcome measures are easy to capture in clinic, he said: the visual analog scale, the 0-to-10 pain score most practices already record, and the Oswestry Disability Index or Neck Disability Index, a 10-question survey patients can complete in the waiting room or through the EHR before their visit.
For a lumbar fusion surgeon, that could look like an average ODI that drops from 57 to 12 across all patients, he said. “They’re going to have a very difficult time arguing with you about your … outcome improvement.”
Physicians who bristle at having to prove their quality need to get past it, he added.
“I know you’re a good doc. Well trained. Now, you’ve got to prove it,” he said.
Doing more for less
Payment cuts are colliding with efficiency gains physicians aren’t credited for, Dr. Verdon said. When he finished training, he said a laminectomy paid about $1,100 to $1,200 under Medicare. Today, he said he’s paid under $950 for the same procedure
Over the same stretch, his operating time for the procedure fell by roughly 30%.
“I’m 30% more efficient, but I’ve taken more than a 30% pay cut on that,” he said.
He can’t simply add cases to close the gap. “I can’t do more surgeries because there’s not enough people to turn the room over,” he said.
Codes also don’t reflect complexity. He recently performed a single-level laminectomy and discectomy on a patient with a BMI above 55 and will be paid the same as if the patient’s BMI were 28. He compared it to Olympic diving, where judges score for degree of difficulty.
“I don’t get that for surgery,” he said.
Medicare quality measures miss what matters most to patients, too, he said. They track whether a patient got an infection — not whether symptoms resolved, how quickly the patient returned to work or what the total cost of care was. ASM is CMS’ first attempt to change that, and physicians who already measure their outcomes will be best positioned when it does.
Process is the strategy
For Dr. Verdon, the fix starts with discipline. Practices and ASCs don’t take in patients the same way or measure the same things, from institution to institution or physician to physician. He pointed to former Alabama football coach Nick Saban, who has described getting players to focus on executing one six-second play at a time.
“I think we lack that discipline in healthcare. Period,” he said.
He expects efficiency pressure to keep driving consolidation — including health systems buying into ASCs — and sees data analytics as the way practices will route patients to the right physician and cut low-value care.
When the final rule drops, his first step is practical: use AI tools such as Claude or Perplexity to dig into what the rule means for a specific practice, down to an individual NPI.
No more bystanders
Physicians were long told to leave the business side to others, Dr. Verdon said.
“We like to stay within our competencies, but the problem is then other people will define those for us,” he said.
He wants physicians to set the standard for how they take in patients and what they measure, then report it.
“We’re not the top of the system. We’re somewhere in the middle of it,” he said. “We’re the major revenue generator, but we’re also the major cost generator too, and the major quality generator and the major complication generator. … We need to start measuring our activity to find out what needs to be improved.”
His advice to peers ahead of the final rule is simple: “Keep your eye on the ball.”
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