Becker's Spine Review

18 PRACTICE MANAGEMENT These CMS changes would significantly improve spine care: 6 surgeons weigh in By Alan Condon F rom revamping codes to reversing prior authorization requirements and increasing reimbursement, six spine surgeons discuss CMS changes that would enhance spine care. Note: e following responses were edited for style and clarity. Question: What's one change CMS should implement that would greatly benefit spine care? Michael Gordon, MD. Hoag Orthopedic Institute (Orange County, Calif.): If the benefit is for surgeons, I would say pay- ment should be risk-adjusted and site of care should be irrelevant so surgeons are paid properly for risk and expertise and to avoid gaming the system on where to do surgery and how long to keep patients in the hospital. 1. [CMS] needs to pay more — spine sur- geons have seen a steady decline in reim- bursement. 2. Coding for outpatient anterior/posterior lumbar fusion is not up to date. 3. e bundled payment system is not good for spine. It needs modification. If the benefit is for patients, I would create ac- cessible, transparent, risk-adjusted outcomes data on each surgeon and facility so they can compare apples to apples when choosing. Christian Zimmerman, MD. Saint Alphon- sus Medical Group and SAHS Neurosci- ence Institute (Boise, Idaho): CPT modifier 22. As all are aware, this code is frequently indicated, but rarely honored by CMS reim- bursements. e duplicative dictations and submissions of patient descriptors, complex- ity and additional time allotments are usually not enough to 'qualify' certain individuals for applied reimbursements. Especially in a patient populace that carries more acuity, risk and complication rates. Our anesthesia colleagues no longer submit with the supple- mental application process of the modifier 22, even in inarguable cases with the highest [American Society of Anesthesiology] scores or body habitus. eir record of recovery of the modifier from CMS is so low. Brian Gantwerker, MD. Craniospinal Cen- ter of Los Angeles: ere needs to be two things. CMS has to suspend budget neutral- ity in order to not gut reimbursements for spine surgeons and their supporting physi- cians. CMS also has to not have such a pa- ternal/maternal-istic view of knowing what's best. What we have seen with [the last] ad- ministration is a dismissive attitude that did not help matters. We hope that CMS will be a better partner in making sure patients get the care they need. Issada ongtrangan, MD. Microspine (Phoenix): e only hope I have is that the CMS will not keep trimming the profession- al fee. As we all know, advanced technology is not without cost, but it is for the patients' outcomes. It is sad to see that CMS looks at the surgical technique as one-all-be-all. For example, the open lumbar fusion is not equal to minimally invasive fusion or endoscopic fusion in terms of the work and instruments each surgeon uses. Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): Spine surgery outcomes have gotten significantly better in recent years, es- pecially with the introduction of such inno- vations as minimally invasive spine surgery, disc replacement, and navigated and robotic surgery. Despite that, CMS reimbursement per procedure has been going down every year for as long as I can remember. Spine care would greatly benefit if CMS can start paying spine surgeons appropriately (commensurate with increasing practice costs, inflation and increasing regulatory burdens) for the work done. In my 11-year career in spine surgery I have seen my Medicare reimbursement for most spine operations decrease every year, even though I can now do them better with better patient outcomes. I am not aware of any other industry where a professional gets paid less for doing the same work as their ex- perience and quality of work improves over the years. Richard Chua, MD, Northwest NeuroSpe- cialists (Tucson, Ariz.): Reverse the decision made last year to require prior authorizations for imaging and surgeries, including outpa- tient surgeries.. n $108M raised by Mainstay Medical to support US launch of back pain implant By Alan Condon M ainstay Medical raised $108 million to fund the launch of its ReActiv8 implant in the U.S. and pursue post-market clinical studies. "We are now strongly capitalized to execute on our corpo- rate objectives in 2021 and beyond, including the launch of ReActiv8 in the U.S. market and acceleration of our commercialization efforts in Europe and Australia," Jason Hannon, CEO of Mainstay Medical, said in a Feb. 16 news release. ReActiv8 is a restorative neurostimulation implant used to treat chronic lumbar pain. The implant stimulates nerves that supply the lumbar multifidus muscle to generate con- traction of the muscle, which can help patients recover from chronic lumbar pain. The funding was raised through an equity financing round that included venture capital firms Sofinnova Partners, Ally Bridge Group and Fountain Healthcare Partners as well as family investment firm KCK Group. n

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