CMS' payment and site-of-care proposed changes for 2022 have caused some head-scratching among surgeons as the agency plans to walk back many of the changes it enacted this year.
Three surgeons discuss how the proposed changes would affect spine care and offer other areas where CMS should focus its attention.
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. We invite all spine surgeon and specialist responses.
Next week's question: What is the worst investment or decision you made in your career? If given the opportunity, what would you do differently?
Please send responses to Alan Condon at acondon@beckershealthcare.com by 5 p.m. CDT Wednesday, Aug. 25.
Note: The following responses were lightly edited for style and clarity.
Question: How will CMS' 2022 proposal regarding payment and site-of-service changes affect spine care?
Brian Gantwerker, MD. The Craniospinal Center of Los Angeles: I believe CMS has a fiduciary duty to protect the integrity of the Medicare Trust, and to make sure patients can get timely access to care. Furthermore, to the physicians rendering care — they should get paid. The lookie-loo game with site of service and cutting physician reimbursements is a circular firing squad. If they want to save money, start penalizing price gouging by pharmaceutical companies; reward physicians for a job well done rather than pyrrhic victory after pyrrhic victory; and stop supporting certification of bodies that deem bouffant caps more "safe" than surgeons' caps and concentrate on real patient safety issues, like having a doctor to see.
Issada Thongtrangan, MD. Microspine (Scottsdale, Ariz.): The migration of spine surgery cases will continue despite CMS' 2022 proposal. Surgeons must have strong surgical indications and a detailed evaluation as Medicare patients tend to be older with significant comorbidities. ASCs must negotiate with all vendors in terms of pricing, especially if we want to use advanced technologies such as endoscopes, minimally invasive surgery, navigation, expandable cages, etc. These are costly, and sometimes can be more expensive than the reimbursement the facility receives. I am also curious about the timing for CMS approval since [anterior cervical discectomy and fusion] and neuromodulation need preauthorization beginning July 1, 2021. The bottom line is that we can't lower our standard due to the cost and payment.
Richard Chua, MD. Northwest NeuroSpecialists (Tucson, Ariz.): Unfortunately, this is really a moving target. Just as CMS' 2022 proposal was about to be enacted, it was reversed. Not sure how it will affect spine care when the rules change so drastically.