Similar to 2024, next year will pose challenges to the spine industry, especially when it comes to payer relations. There are also new opportunities for the specialty to develop new technologies.
Five surgeons discuss what's ahead.
Note: Responses were lightly edited for clarity.
Question: What are you expecting from the spine field in 2025? What does a successful year look like for your practice?
Benjamin Elder, MD, PhD. Mayo Clinic (Rochester, Minn.): Hoping to see continued development of enabling technology and patient-specific construct designs, with improved AI algorithms particularly in the deformity space, while maintaining reasonable costs. With a new federal government administration, I'd also like continued focus on addressing the challenges and inefficiencies of insurance prior authorization, with both private payers and especially with Medicare Advantage plans.
A successful year will be maintaining my clinical practice on spinal deformity and increasing my time dedicated to my bone and cartilage tissue engineering lab as well as resident and fellow spine education.
Brian Fiani, DO. Spine surgeon. (Birmingham, Mich.): From my perspective, the field of spine surgery in 2025 is likely to focus on several key areas:
1. Advancements in Technology: I expect to see continued integration of advanced technology such as robotics, artificial intelligence, and augmented reality in surgical procedures.
2. Minimally Invasive Techniques: The trend toward minimally invasive surgeries will likely expand.
A successful year for my practice involves practice expansion, including geographically, and with continued multispecialty engagement. Working in collaboration with other specialists builds a successful practice for me. Inter-professional relationships and building trust within the community through outreach programs, workshops, or seminars to educate the public about spine health and prevention is a winning mechanism for success. Overall, a successful year is one where both patients and the practice see growth, improvement, and shared victories in spine health!
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: In 2025, there will be further advances in arthroplasty, robotics, and endoscopic spine. We will likely see further problems in Medicare and reimbursement. The incoming administration seems to be leaning towards Medicare Advantage being the de facto choice for new recipients entering Medicare age. As we have seen with the negative value add and the fraudulent upcoding committed by the bad actors in this space, it will get worse. It seems Medicare insolvency is bad, but giving people's hard-earned money to the insurers and having them mismanage it further by Uber-rationing care seems hypocritical. The main thing is that the only thing that will keep our system solvent is by: payment adjustments for inflation for physicians, enforcing current laws on antitrust and corporate malfeasance, breaking up large insurers, limiting clawbacks to one year, linking payment to authorization and enforcing the medical loss ratio.
Lali Sekhon, MD, PhD. Spine Surgeon at Reno (Nev.) Orthopedic Center: 2025 from 2024 - Rinse and repeat.
We will deal with the same issues:
1. Dwindling reimbursements
2. Prior authorizations
3. Pushing what we can to physician owned ASCs
4. Examine our own practices in an honest fashion and focus on what we can improve.
As always, the right answer is to put the patient's interests first. That is something that mainstream pharma, big hospital systems and payers don't prioritize but we physicians always do.
Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho): Looking at payer trends in health insurance has historically and regrettably continued to decline for providers and specialists alike. CMS proposals for provider and institutional changes are currently slated to decline (2-4%), with such economic emphasis on budget cuts, fraud, abuse and deficit discussion being the most prevalent concentration points of the newly elected. Conversely, with a renewed top of mind business reparation/outlook, tax reductions for small and large businesses, and reliable energy sourcing, the cost differential of manufacturing and delivery may offset the real price gouging of late. The reverberation will flow to all aspects of care and ultimately slow innovation and implementation.
Success remains in the service and outcomes of spinal surgery to our community and afflicted patient populace. Commitment is a team methodology and having that in place bodes well for that delivery as it has for years. Large health systems provide all the service disciplines, which enable a complex spine practice, as secular, for-profit centers continue to filter patient insurance and acuities. Providing the many services that are non-discriminatory is a success.