Becker's ASC Review

13 ORTHOPEDICS Consolidation, 'granular' data crucial to orthopedics in 2026: Dr. Brian Cole By Carly Behm A s healthcare costs rise and reimbursements lag behind, OrthoMidwest is doubling down on data-driven growth, Brian Cole, MD, said. OrthoMidwest was formed in 2023 and is an aggregation between Chicago-based Midwest Orthopaedics at Rush and Rockford-based OrthoIllinois. And in 2024 the aggregation added Peora, Ill.-based OSF Health. Dr. Cole, managing partner at Midwest Orthopaedics at Rush, spoke with Becker's about his top priorities with OrthoMidwest and the healthcare trends orthopedic surgeons should follow in 2026. Note: is conversation was lightly edited for clarity. Question: How are you thinking about growth with OrthoMidwest? Dr. Brian Cole: It's now one of the largest regional groups aer our aggregation in 2023. We're now growing our footprint with increased aggregation efforts. We still are living in an industry where we're faced with all the economic challenges such as increasing costs of doing business, cost of living, inflation and so forth. e challenge we have is that pricing and insurance reimbursement usually either stays the same or goes the opposite direction relative to the cost of business, which continues to increase on a yearly basis. With Medicare cuts, Medicaid cuts and CMS changes on an annual basis, we're still seeing headwinds related to reimbursement that are not tracking with the increased cost of practicing medicine. Patient access is also still a challenge, and what's happening is essentially physician practices are starting to underwrite the process because we oen don't have the ability to navigate the payer environment. It oen comes back to data in terms of quality and the impact that quality has on patient outcomes and preventing complications and reoperations. e hope is that the data will resonate with payers as a value proposition that is not just a better outcome, but leads to improved economics as it relates to delivering care. We're going to improve our ability on the outcomes data front, and that helps clinicians be better. In other words, understanding what their outcomes are, what their decision making is, and our focus has really been on providing quality care. Now we have the ability to The nuances of 'unnecessary' spine surgery By Carly Behm T he Lown Institute reported that spine surgeries deemed "unnecessary" have cost Medicare billions of dollars but the findings don't show the full picture, some surgeons say. Two spine surgeons share their perspectives. Note: Responses were lightly edited. Question: "Unnecessary" spine surgeries have cost Medicare almost $2B over three years, according to the Lown Institute. What's needed from physicians, devicemakers and policymakers to address this? Fred Naraghi, MD. Sky Lakes Health System (Klamath Falls, Ore.): While the Lown Institute raises valid questions about value in spine care, its conclusions risk oversimplifying the nuanced decisions that we as spine surgeons face daily. Many procedures labeled "unnecessary" are performed for patients who have failed every conservative option and are desperate for relief. The real solution may require collaboration, refining indications, strengthening shared decision-making, tracking outcomes through national registries, and payment models that reward outcomes and not just volume. Device makers should focus on evidence, not marketing, and policymakers should encourage quality without fueling insurance denials that already delay care egregiously. A fairer RVU model would reward outcomes and patient satisfaction alongside volume and technical skill. Of course, such a balance between payers, policymakers, and surgeons may only happen when we all achieve spine- care nirvana! David Skaggs, MD. Cedars-Sinai (Los Angeles): While this analysis is well-intentioned, it is fundamentally limited by its methodology. Coding data cannot capture the complexity of spine pathology or the clinical reasoning that drives surgical decision-making. Labeling operations as "unnecessary" based on administrative codes oversimplifies a nuanced process that weighs anatomy, function, pain, and patient goals. That said, perception matters — and the spine community should confront concerns about overuse head-on, not dismiss them. At Cedars-Sinai Spine, we've built structural safeguards into our process. Every elective case undergoes rigorous peer review by both orthopedic and neurosurgical spine faculty before proceeding to the operating room. These 6:30 a.m. conferences are demanding and uncompensated, but they often lead to real changes: modifying the planned procedure, delaying surgery for further conservative care, or determining that no surgery is warranted. Peer scrutiny isn't always comfortable, but it's essential. Our aim isn't to defend every spine surgery — it's to make sure each one stands up to scrutiny. n

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