Becker's Spine Review

8 SPINE Spine surgeon pay hits $844k By Laura Dyrda T he average orthopedic spine surgeon salary nationwide is $844,422, according to the 2022 Medical Group Management Association Compensation & Production Report. Physicians Thrive noted some orthopedic spine surgeons make much more. Surgeons on the 90th percentile make $1.4 million while those on the other end of the spectrum, the 10th percentile, make $468,787, according to MGMA. The report also noted spine surgeons earn around 7% more in multispecialty practices than single-specialty practices, and surgeons in a physician-owned facility typically make 5% more than their colleagues working at a hospital. Despite the higher pay in physician-owned practices, many spine surgeons coming out of training are opting to sign hospital contracts. The highest compensating practice location is metropolitan areas with a population of fewer than 250,000 people, where the median salary is $882,502. In more densely populated cities where the market is potentially saturated, orthopedic spine surgeons earn between $589,540 and $831,366. Spine surgeons can add to their income through a variety of ways, including ownership in a surgery center. As more spine procedures are approved for the outpatient setting, surgeons are taking action. "Considering the looming cuts in Medicare reimbursement for our services in the setting of increased expenses, we are facing significant headwinds that make the practice of medicine almost untable for surgeons, and our industry partners alike," said Peter Whang, MD, professor in the department of orthopedics and rehabilitation at Yale University School of Medicine in New Haven, Conn. "In response to these challenges, I believe that we will see an even greater shift of orthopedic and spinal procedures to the outpatient setting in an attempt by surgeons to establish more diverse income streams while providing more cost-effective care." n ACDFs have 'unacceptably poor cost-utility' in hospitals By Laura Dyrda A nterior cervical discectomy and fusion costs significantly less when performed in ASCs than the hospital setting for Medicare and privately insured patients, according to a study published in the Dec. 15 edition of Spine. Researchers examined data from 6,504 patients from the Quality Outcomes Database who underwent one and two level fusions. ere were 520 patients who underwent the surgery in ASCs compared with 5,984 patients who had their procedures done in a hospital. e study authors identified 748 patients for the analysis, 374 per cohort, aer propensity matching. Four findings: 1. Total costs for spinal fusion in the ASC at one year were $5,879.46, compared with $12,873.97 for procedures in the hospital. 2. e inpatient ACDF incremental cost-effectiveness ratio was $3,674,662 for Medicare patients and $8,046,231 for privately insured patients. e results showed "unacceptably poor cost- utility," according to the study authors. 3. Complication rates, patient-reported outcome measures and QALYs were similar for the patients who underwent surgery at the hospital and ASC. 4. Study authors concluded, "e ASC setting is a dominant option from a health economy perspective for first-time onelevel to two-level ACDF in select patients compared to the inpatient hospital setting." n spine procedures is that endoscopy utilizes direct-light based visualization of anatomy, akin to using a microscope and a tube — just on a miniature scale. Hence, coding should reflect that. Payers still sometimes deny these procedures as 'experimental,' despite some of the best randomized controlled studies in spine surgery affirming their benefits and at minimum, equivalence in outcomes." Robert Rothrock, MD, director of spinal oncology at Miami Neuroscience Institute said the word "experimental" was a frustrating description of endoscopic spine. "When you say 'experimental,' to a surgeon, we have a very guttural response to that. Because [this technology] is not experimental," Dr. Rothrock said. "We're not experimenting on our patients. e [insurance] industry has termed it experimental because they don't feel they have sufficient long term outcomes data." Dr. Gallizzi, Dr. Hasan and Dr. Rothrock all emphasized the importance of research and gathering data for endoscopic spine surgery to help improve payer interest and reimbursements. "e onus is on us as a community to perform research that is credible and ethical, such that we perform evidence-based surgery," Dr. Rothrock said. "My attitude is that there's enough of a foothold in the community of spine surgeons that I think [reimbursements] will get there, and that's why I'm more positive about it." n

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