Issue link: https://beckershealthcare.uberflip.com/i/293049
16 Sign up for Becker's Orthopedic, Spine Business & Pain Management E-Weeklies at www.BeckersOrthopedicandSpine.com or call (800) 417-2035 all spell decreasing reimbursement for the spinal surgeon and for the implant industry. Bundled payments will have to affect payments further, decreasing surgeon reimbursement and device reimbursement. The surgeons understand this as this has been going on now within various payment systems for a while. The effect on industry is likely to be a reduction in return on investment on the margin and squelch innovation. If innova- tion does indeed influence patient care, then im- provement in patient care could also be slowed. The acquisition of medical practices (the AMA states that 50 percent of surgeons in the U.S. are now employed) and the consolidation of large hospital systems and insurance companies are going to move control of reimbursement further and further from the surgeon, no matter what the fine details of the Affordable Health Care Act turn out to be. Under- standing and managing multiple performance re- porting programs and their resulting administrative burden continue to be challenging as well. Q: What coverage and reimbursement issues are most pressing for spine sur- geons today? WW: At the Centers of Medicare and Medicaid Services level, the major issues are the re-valuing of CPT codes and the bundling of CPT codes, which have the same effect. When CMS re-sur- veys a particular CPT-coded procedure, previous- ly done on a five-year basis, but now even more frequently because of changes in the coding sys- tem or introduction of new technology, the result seems to inevitably be a decrease in the relative value of existing procedures. An example of this is the recent bundling of the code for a cervical discectomy with that of the cervical fusion following that discectomy into a single code, of lesser value than the two previous codes combined. At the private payer level, the issue is non-coverage decisions based on non- transparent, internal guidelines of questionable validity and source. This used to be a particular problem with new tech- nology, but we now see an almost relentless attack on previously accepted procedures (i.e. lumbar fu- sion for disc disease) denying these procedure as being "experimental" or "investigational," which of course is a perversion of these terms. Q: Where do you see the biggest opportu- nities for spine surgeons to be successful in the future and to make significant con- tributions to the field? WW: [At the 2013] NASS Annual Meeting in New Orleans, I had the opportunity to have an in- teractive session with several hundred NASS sur- geon members recently out of their residency and fellowship training. This was an "Ask the Presi- dent" session and was great fun, bringing back many happy memories of my own development. But there was tension in the room also concerning the future, happiness in their choice of profession and the whole question of reimbursements and their decline. My answer on this front was clear: If you have entered spine surgery because you truly love do- ing it, you like innovation and you value helping people, you will still make a comfortable living and have a satisfying career. However, if you en- tered spine surgery for the simple reason that it has carried some of the highest reimbursements in recent years and you expect to carry on such a practice, you are likely to be very disappointed and unhappy with your career. So the biggest opportunity for spine surgeons to be successful pretty much depends upon how you define "success." It is that simple. With respect to making significant contributions in the field beyond excellent patient care, I feel an academic career still holds the best promise for making sig- nificant contributions in both clinical and labora- tory research. n