Becker's ASC Review

14 ORTHOPEDICS Physician shortage could spell 'doomsday' for orthopedics By Riz Hatton e looming physician shortage poses a unique threat to orthopedics. John Christoforetti, MD, an orthopedic surgeon at the Centers for Advanced Orthopaedics in Bethesda, Md., connected with Becker's to answer, "How will the overall physician shortage affect the orthopedic industry?" Editor's note: is response has been lightly edited for length and clarity. Dr. John Christoforetti: Lookout, it could be doomsday! Let's hope not. e increasing gap between the demand in society for flawless and inexpensive medical care and the available workforce will impact the delivery of orthopedic care in ways we cannot fully anticipate, but I believe it will push orthopedics more than many other areas. Reduced new talent, unique challenges in orthopedic training and reductive market forces all conspire to uniquely challenge our industry. Perhaps the most challenging aspect is reengaging the best and brightest undergraduate students from a diverse population to consider a career in medicine. As a parent of teens and college-aged children, I oen hear their peers comment on how long, expensive and risky the path to a medical career appears. e top colleges in the U.S. are now imposing the most stringent entrance requirements for their business programs, promising a shorter return on investment compared to fields like medicine or surgery. ese post-pandemic learners find it harder than ever to imagine the long hours on-site as other fields promote work from home, lifestyle harmony, high compensation and low risk of litigation. Many of today's rising stars choose to assuage their desire to work in medicine by planning careers in medical device, soware or organizational leadership once they realize that orthopedic surgery residency and fellowships are lengthy and not guaranteed opportunities even aer they commit to medical school. is is fueling a potentially deeper cut in the availability of orthopedics than in other areas of medicine. Some experts suggest that there is a chance that patients will find it increasingly difficult to have access to high-quality surgical procedural care in all but the most densely populated urban areas. Correspondingly, under the banner of cost containment, third- party payers' continued reduction in covered services for patients and professional fees for surgeons will bankrupt all but the payers themselves. With our best and brightest well-trained to sell products or administrate and few around to be at the bedside or operating room table to deliver care, we may also find a drop in the appeal of the industry as a whole. is is a doomsday scenario that will likely not fully come to happen, but we should consider it carefully. I like to take an optimistic viewpoint that by consolidating experienced orthopedic traditions in physician-owned and operated practices, we can protect and promote innovative new ways to leverage technology and nonphysician talent for hands-on care. Even our organization will need to embrace education and competitive staffing practices to keep the flame of interest burning in the next generation. Aer all, a career in orthopedics is a great gi for those of us who are fortunate enough to get the chance. n New CMS rule aims to improve pain point for spine surgeons By Carly Behm CMS on Jan. 17 finalized a rule to improve the prior authorization process. The new rule will require some payers to send prior authorization decisions within 72 hours for expedited requests and seven calendar days for standard requests, according to a news release. The rule, which goes into effect in 2026, will cut the decision timeframe in half for some payers. Affected payers will also have to include specific reasons for denying a prior authorization and publicly report prior authorization metrics. They will have to implement a Health Level 7 Fast Healthcare Interoperability Resources prior authorization API to improve efficiency for electronic processing. For many spine surgeons, prior authorizations impose a hurdle in patient care. In June 2023, neurosurgeons were calling on the U.S. Department of Health and Human Services and CMS for improved prior authorization rules. "What we need more than ever is fair prior authorization practices to be put in place," Brian Gantwerker, MD, of The Craniospinal Center of Los Angeles, said last year. "Insurers have increasingly outsourced their authorization duties in order to save themselves money and to absolve them of arbitrary medical decisions by local and state rules. This has become customary and obstructionist and benefits only their shareholders. If Congress and HHS are serious about saving money, they need to stop letting insurers dictate the rules of engagement and stop blaming physicians who are fighting on behalf of their patients." CMS' new rule also updates API requirements to "increase health data exchange and foster a more efficient health care system for all," according to a news release. Affected payers will have until Jan. 1, 2027, to expand their API to include prior authorization information and implement a Provider Access API. n

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