Medicaid cuts are an ongoing worry in healthcare, and spine surgeons discuss what they mean for their work.
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: What changes would you like to see in CMS policies affecting spine procedures? Why?
Please send responses to Carly Behm at cbehm@beckershealthcare.com by 5 p.m. CST Tuesday, April 15.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: What would Medicaid cuts at the federal level mean for spine surgery access? Would it force more independent spine surgeons to stop taking Medicaid patients?
Philip Louie, MD. Virginia Mason Franciscan Health (Seattle): This is an incredibly complex — and honestly, a bit scary — situation. As a spine community, we find ourselves in a dual role: fighting to preserve access and funding on a national level while simultaneously preparing to adapt responsibly if changes occur. The goal is to protect current and future patient care, while also preserving the financial sustainability of our practices and health systems and quite frankly, our own bandwidth and well-being.
I view these changes through two lenses: my fears and my hopes.
My fears:
– Independent practices may be pressured to opt out of Medicaid, as reimbursements will not cover the true costs of spine care services. These practices cannot cross-subsidize low-reimbursing cases like larger hospital systems can.
– Independent practices may fold and join larger hospital systems or private equity-backed groups for operational support or access to more favorable payer contracts.
– Access inequities will worsen. Medicaid patients — who already face longer wait times and fewer options—may be further marginalized as fewer providers are willing or able to take them on.
My hopes:
– Creative partnerships will emerge. Instead of consolidation, independent practices may find new ways to co-manage infrastructure, partner with [federally qualified health centers]s, or collaborate with Medicaid-focused [accountable care organizations]. It’s about sharing resources without giving up independence.
– Jump start innovation toward care models that somehow target resource distribution: prioritizing higher impact, cost-effective treatments. Medicaid patients are generally more complex with higher risks. Maybe we will be able to better risk optimize [or] treat this population in a more effective and economically friendly way.
Issada Thongtrangan, MD. MicroSpine (Scottsdale, Ariz.): In my opinion, federal Medicaid cuts could significantly impact spine surgery access, particularly for patients relying on Medicaid for coverage. If reimbursement rates drop further, independent spine surgeons may find it increasingly difficult to accept Medicaid patients, as lower payments often fail to cover the full cost of procedures. This financial strain could push more independent surgeons to limit or stop accepting Medicaid patients altogether, further restricting access to specialized spine care.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Proposed federal cuts in Medicaid funding will affect most states’ budgets [ability] to supply healthcare to the underserved and uninsured. That percentage will vary depending on legislature and financial fitness, but historically speaking, that reduction will occur. These cuts markedly affect the pricier forms of healthcare, so complex spinal surgery will be sighted.
Locally, only the health system-employed physicians currently administer to the underserved patient population, as controversial investiture in exclusionary care models prohibit acceptance. This has been the standard for many years as reimbursements to both hospitals and physicians for community-based care has been limited. While hospitals attempt to shift this burden to a few willing providers, the demand/supply of providers continues to grow divergently.
