Becker's ASC Review

64 ORTHOPEDICS CMS changes that spine surgeons want to see By Alan Condon T hree spine surgeons have proposed Medicare changes that they say would significantly improve spine care. 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. Michael Gordon, MD. Hoag Orthopedic Institute (Orange County, Calif.): 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 surgeons have seen a steady decline in reimbursement. 2. Coding for outpatient anterior/poste- rior 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 cre- ate accessible, transparent, risk-adjusted outcomes data on each surgeon and facil- ity, so they can compare apples to apples when choosing. Vladimir Sinkov, MD. Sinkov Spine Center (Las Vegas): Spine surgery outcomes have gotten significantly better in recent years, especially 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 in- dustry where a professional gets paid less for doing the same work as their experience and quality of work improves over the years. n 7 numbers making orthopedic surgeons nervous By Laura Dyrda O rthopedic surgeons had a tough year in 2020, with many elective procedures canceled or postponed, leaving some to speculate that case volume may never recover. At the same time, the number of people needing total knee replacements in the U.S. likely will increase as the Baby Boomer population ages and people aim to stay active longer. Seven numbers reflecting challenges ahead for orthope- dic surgeons: 1. Orthopedic surgeon pay is flat: The average annual pay for orthopedic surgeons is $511,000, the same as in 2020, according to Medscape. Orthopedists also fell from the highest-compensated specialty in the report, with plastic surgeons reporting the highest average pay at $526,000. 2. Incentive bonus: 16 percent of orthopedic surgeons earn less than 1 percent of their annual incentive bonus, according to Medscape. 3. Orthopedic income levels: 12 percent of orthopedic surgeons said they don't anticipate ever returning to pre-COVID-19 income levels, which dropped during the pandemic. Nearly half do anticipate returning to pre- COVID-19 income levels in two to five years, according to Medscape. 4. Physician employment: 70 percent of physicians are employed by hospitals or corporations, accord- ing to Avalere. While many orthopedic surgeons are independent, their referral networks in many regions are disappearing as hospitals purchase primary care physician groups. 5. Patient volume drop: 45 percent of independent or- thopedic surgeons think their patient volume drop of up to 25 percent is permanent, according to Medscape. 6. Total knee replacement jump: From 2018 to 2030, the number of total knee replacements is expected to increase 673 percent to 3.5 million procedures, ac- cording to the American Association of Hip and Knee Surgeons. Without a dramatic increase in surgeons performing total joints, or without a change in potential treatments, patients may experience barriers to care in the next decade. 7. Orthopedic surgeon shortage: By 2025, the Health Resources and Services Administration predicted the U.S. will be short 5,080 orthopedic surgeons, according to a Merritt Hawkins report. Around 60 percent of orthope- dic surgeons were 55 years or older in 2018, potentially preparing for retirement in the next 15 years. n

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