CMS’ proposed Medicare payment policy includes another 1.68% cut to reimbursements for surgeons.
The CMS calendar year 2027 Medicare Physician Fee Schedule’s proposed rule could have an even larger effect on spine and orthopedics. Specialty-level analysis estimates that orthopedic surgery payments would decline an additional 7% and that certain orthopedic procedures could see cuts of up to 20%.
With reimbursements remaining stagnant, and in many cases declining, physicians are calling for sweeping changes to the system that include more predictable, stable payments.
These two surgeons recently spoke with Becker’s about changes to the physician fee schedule that would make a real impact.
Editor’s note: Responses have been lightly edited for clarity and length.
Question: CMS recently proposed a 1.68% cut to the physician fee schedule, yet another reduction in pay for physicians. What would actually move the needle at this point: congressional action, tying pay to inflation or something else?
David Bailie, MD. President of the Arizona Institute for Sports Knees and Shoulders (Scottsdale): My take is having others decide how much to pay a physician leads to many issues, including surgeons doing procedures by volume to make up for the low reimbursement. I went to no insurance almost 10 years ago for that reason as I do not think insurance or CMS has a right to decide the value of a specific surgeon’s services. The market should decide. I charge a fair fee and have remained very busy under this method without gouging patients. When a third party decides what should be paid then things become problematic. I think the physician fees should be decided by the market.
The entire system needs to be changed. I believe private insurance needs to be mandated by Congress to not be for-profit or publicly traded. They should be mutual companies with excess year-end savings given back to policyholders as a dividend. Companies who do well managing and providing good services will survive. Too many people are taking the money out of the system — funds that should be used for medical care.
CMS is a different story, as Medicare is charity work. I think all doctors should do it in some form as a contribution to society, but I think they should be able to limit it to 10 to 15% total at most. Quality will suffer as in any service business when someone else wants to control fees.
Alexander Lazarides, MD. Orthopedic Oncologist of Moffitt Cancer Center (Tampa, Fla.): The recurring cycle of annual physician payment cuts is no longer simply a reimbursement issue. It is a patient access issue. As an orthopedic oncologist, I care for patients with sarcoma and metastatic bone disease whose treatment often requires multidisciplinary coordination, complex surgical planning and highly specialized care that is available at only a limited number of centers. Preserving access to that expertise should be a national priority.
What would truly move the needle is a physician payment system that provides predictable, annual updates tied to inflation and the actual cost of delivering care, rather than relying on temporary congressional fixes year after year. At the same time, reimbursement should better recognize the growing complexity of modern medicine, including care coordination, multidisciplinary decision-making and the cognitive work required to care for patients with challenging diseases.
A sustainable payment model is essential to maintaining the physician workforce, supporting innovation and ensuring patients continue to have timely access to specialized care. When reimbursement steadily declines while the cost and complexity of care continue to rise, the greatest risk is not to physicians. It is to patients who depend on access to highly specialized treatment that cannot be easily replaced.
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.