Becker's ASC Review

38 SPINE AAOS president warns of orthopedic practice closures under Medicare proposal By Sophie Eydis W ilford Gibson, MD, president of the American Academy of Orthopaedic Surgeons and partner at Virginia Beach, Va.- based Atlantic Orthopaedic Specialists, knows how little financial cushion an independent medical practice can have. During the COVID-19 pandemic, his group's physician partners stopped taking paychecks temporarily so they could continue paying employees. Even under normal circumstances, he said, independent practices operate with little excess cash. "We go month to month, really payroll to payroll," Dr. Gibson told Becker's. at is the lens through which he views CMS' proposed 2027 Medicare Physician Fee Schedule. He worries some of its reductions could push independent orthopedic groups toward decisions that are difficult to reverse: selling to hospitals, taking private equity deals, limiting certain patients, closing rural offices or retiring early. "is is one of the most dangerous and severe situations I've seen in the 30-plus years I've been in practice," he said. AAOS argues the issue extends beyond physician compensation. e organization believes Medicare payment policy could accelerate consolidation and push care from independent practices into larger systems with different cost structures. CMS says the proposed rule is intended to advance quality, efficiency and innovation while updating how physician services and practice expenses are valued. e rule could change before taking effect Jan. 1. is is not a routine Medicare cut e proposal would reduce Medicare's conversion factor by 1.19% for qualifying alternative payment model participants and 1.68% for other clinicians compared with 2026, largely because a temporary 2.5% physician payment increase expires at year-end. But Dr. Gibson is more concerned about changes to individual orthopedic services. e OrthoForum, an alliance of independent orthopedic practices, estimates proposed changes could reduce physician reimbursement for total hip and knee replacements by approximately 20%. Dr. Gibson said cuts of that magnitude are difficult to absorb as practices also face rising costs for staff, malpractice coverage, health insurance and technology. "We essentially never get an inflationary adjustment to keep up with inflation," he said. CMS is also proposing changes to its practice expense methodology to rely on more current and auditable cost information. AAOS has asked the agency to pause the new payment values and maintain 2026 levels while physicians and policymakers work toward a longer-term approach. When payment policy becomes consolidation policy Dr. Gibson expects deeper Medicare reductions could lead some independent practices to consider hospital employment, private equity offers, reduced payer participation or leaving traditional practice. He worries that could undermine Medicare savings if more care shis from physician offices and ASCs into higher-cost settings. e concern is a paradox: Cutting physician reimbursement may reduce one area of Medicare spending while changing the market in ways that increase costs elsewhere. AAOS also argues consolidation could leave patients with fewer choices and less access to musculoskeletal care, particularly in rural communities. Rural access has nowhere to shi When an independent orthopedic practice disappears in a large metropolitan area, patients may have another option nearby. In rural communities, they may not. "Some practices in rural areas are going to realize it's just much too risky to stay open," Dr. Gibson said. Patients with fractures, severe arthritis or other musculoskeletal conditions may instead turn to community emergency departments before being transferred elsewhere, assuming another orthopedic surgeon and hospital capacity are available. "ere's no longer anyone there," Dr. Gibson said of communities that lose local orthopedic coverage. "ey'll have to be seen in the emergency room, temporized and then referred to other centers." He does not predict how many practices would close if the proposal becomes final. His concern is that communities with only one orthopedic access point have little ability to absorb a loss. A payment rule can change the patient visit Another proposal would reduce payment when physicians provide a separately identifiable office visit and certain procedures on the same day. e highest-priced service would receive full payment, while other qualifying services generally would be paid at 50%. CMS says the policy reflects efficiencies when services occur during the same encounter and addresses potential duplicate payment. "is is one of the most dangerous and severe situations I've seen in the 30-plus years I've been in practice." — Wilford Gibson, MD, president, American Academy of Orthopaedic Surgeons

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