Becker's ASC Review

22 ORTHOPEDICS Spine surgeons can thrive without CMS. Here's how By Carly Behm D eclining CMS rates and increased payer obstacles have led some spine surgeons to drop insurance contracts, including Vladimir Sinkov, MD. Dr. Sinkov, of Sinkov Spine in Las Vegas, shared his strategies and how surgeons can balance patient needs and their business. Note: is response was lightly edited. Question: Regardless of your own approach, can cutting ties with insurers and/or Medicare be a feasible option for spine surgeons? What considerations should physicians weigh? Dr. Vladimir Sinkov: Yes, it can definitely be a feasible option for a spine surgeon. My single-provider practice specializing in minimally invasive spine surgery was fortunate enough to be able to drop all health insurance contracts including Medicare about three years ago and we are thriving! I am able to provide the best and most personalized care to my patients and spend as much time with them as they need/want without the pressures of keeping high patient volume or trying to adhere to all the rules and regulations that come with insurance contracts. It is definitely not easy to do in the U.S. healthcare system that is essentially run and controlled by Medicare and health insurances. ey try their best to keep doctors financially dependent on staying "in-network" and at the same time convince patients that the only way that they can get health CARE is through a health INSURANCE. Fortunately, more and more doctors and patients realize that there is a better way. Direct primary care and direct specialty care practices are growing every year. If a spine surgeon wants to go insurance-free, it is certainly feasible, but just like any other business decision, it needs to be carefully thought through and planned. ey need to make sure that their practice location is able to support a sufficient number of patients that are able, and more importantly willing, to pay cash for quicker and easier access to spine surgeons without the interference of an "insurance" company. Being able to perform a spine surgery at an ASC instead of a hospital can significantly decrease the facility costs for the patient. I would strongly advise having a practice manager and staff that are fully on-board with such a plan and who will do the necessary background work in such a cash practice so that the surgeon has sufficient time to concentrate on patient care. At their core, the traditional American health "insurances" (including Medicare) are not even insurances. e primary goal of having any kind of real insurance is to safeguard yourself from unexpected and potentially catastrophic financial losses. Most health "insurances" however are more like health care administering and processing companies that make routine and expected medical care more cumbersome and much more expensive, while trying to discourage patients from receiving expensive and unexpected care such as trips to ER, surgeries, or cancer treatments. Fortunately, more and more doctors and patients are realizing this and finding better ways to provide and receive high quality personalized medical care including spine surgery. n Unnecessary spine surgeries cost Medicare $1.9B: 6 notes By Carly Behm O ver three years unnecessary back surgeries have cost Medicare an estimated $1.9 billion, according to an analysis from the Lown Institute. Six things to know: 1. The Lown Institute evaluated Medicare fee-for-service claims from 2021 to 2023 and Medicare Advantage claims data from 2020 to 2022, according to an Oct. 8 news release. Overuse in spinal fusion/laminectomy patients was deemed for patients with low-back pain who did not have radicular symptoms, trauma, herniated disc, discitis, spondylosis, myelopathy, radiculopathy, radicular pain or scoliosis. Overuse for vertebroplasty was defined in patients with spinal fractures caused by osteoporosis, excluding patients with bone cancer, myeloma or hemangioma. 2. Physicians performed more than 200,000 unnecessary back surgeries on older adults, the Lown Institute found. 3. California and Florida had the highest volume of unnecessary spinal fusions, and both states had more than 6,000 cases that met the criteria for overuse. 4. Texas and Florida had the highest volume of unnecessary vertebroplasties. Texas had 9,937 overuse cases, and Florida had 8,302 overuse cases. 5. "Like everyone in America, older people with back pain deserve safe, evidence-based care that doesn't waste taxpayer dollars," Vikas Saini, MD, president of the Lown Institute, said in the release. "Reducing unnecessary procedures, particularly invasive ones that carry grave risks, is a moral imperative. Physicians, policymakers, and hospitals must act to protect their constituents and patients." 6. The Lown Institute's findings come around a time when CMS is targeting overuse of medical services. One of those initiatives is the Wasteful and Inappropriate Service Reduction Model which includes vertebroplasty and 16 other procedures. n

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