Policy updates with CMS remain a headwind for physicians in all areas of healthcare. Here are five updates for spine surgeons to know in 2025.
1. The Senate voted March 14 to approve a government funding bill that extends key healthcare provisions, delays Medicaid disproportionate share hospital cuts and provides additional support for rural hospitals.
The bill didn’t address the 2.83% Medicare physician pay cut, a major setback for physicians and medical groups, something spine surgeons previously expressed concern over.
“Margins for treating Medicare patients are already narrow, and small private practices do not have the benefit of site of service differentials that the hospital-owned practices do,” Richard Kube, II, MD, said. “It is already difficult to provide various services for Medicare patients, and we currently refer some patients out to avoid operating at a loss. This action by Congress will further limit physician choice and access to care for Medicare patients.”
2. Along with the physician pay cut, CMS’ 2025 Medicare Hospital Outpatient Prospective Payment System and Ambulatory Surgical Center Payment System includes new coding and payment policies for advanced primary care management services. Eligible accountable-care organizations with a history of success can also receive an advance on their earned shared savings.
3. ASCs that meet quality reporting requirements will see a 2.9% pay bump, according to the new rule.
4. Unnecessary spine procedures have cost Medicare more than $2 billion over three years, according to the Lown Institute.
5. Up to 5 million adults could lose their Medicaid coverage by 2026 due to bureaucratic hurdles and reporting challenges, according to a March 17 analysis from the Urban Institute. The policy shift could exacerbate strain on emergency departments, disrupt continuity of care and exacerbate health disparities, particularly in rural and underserved communities.
