Reimbursements have been a pain point for many spine and orthopedic surgeons in recent years, and their changes have affected how care and business is done.
Here is how four surgeons are thinking about them:
1. Reimbursement challenges may play a role in shifting spine procedures out of hospital settings.
"Traditionally, spine surgery is conducted in an inpatient setting," Joel Beckett, MD, said. "With continued technological advancements and the development of minimally invasive techniques coupled with continued changes in reimbursement, this 'default inpatient' needs to be phased out. Across the country, forward-thinking spine surgeons and centers are conducting safe and efficient outpatient surgery. Ultimately, this change benefits both individual patients and decreases the cost burden on the health system as a whole."
2. Reimbursements can pose an obstacle to adding new spine and orthopedic technologies to hospitals and practices.
"The biggest challenge when introducing a new spine procedure is often obtaining buy-in and approval from hospital administrators and committees, due to the significant capital investments required to implement these technologies," Michael Gallizzi, MD, said. "This is particularly challenging when surgical reimbursement rates are declining, making hospitals less likely to invest in technologies for procedures that are already being performed."
3. Reimbursement rates continue to be an operational challenge for many surgeons.
"The biggest threats to the orthopedic industry are rising costs and decreasing reimbursement," Matthew Harb, MD, said. "The costs associated with running an orthopedic practice have significantly increased, a trend that has become incredibly evident in the past few years. The cost of rent, payroll, supplies, equipment and employees have all surged in recent years. This forces practices and providers to either see more patients in shorter amounts of time, cut staff, shut down practice locations, or fall victim to a private equity buyout — all of which has diminishing effects on patient care. To make the situation worse, reimbursement has failed to keep up with inflation. Instead, it has declined year-over-year, stressing the situation further.
4. A push for increased awareness and teamwork with other groups is an ideal path for physicians to push back against CMS' proposed reimbursement plan for 2025, according to Morgan Lorio, MD.
"A best action plan of advocacy and policy engagement will include collaboration with the American Medical Association (AMA) — creating a united front — so as to engage with lawmakers to push for legislative adjustments to ensure fair compensation; and raising public awareness through social media platforms about the issue among stakeholders and the general public, highlighting the impending impact on patient care.
The PFS conversion factor has decreased by $3.73 from 2020 to the proposed 2025. This represents a percentage decrease of approximately 10.33%. This substantial decrease highlights the significant impact on physician payment rates over this period. Mitigating the impact of the reduced conversion factor on physician-surgeons should be a national health priority."