Spine Surgeons Navigate Federal Policy Changes Impacting Practice Viability

Spine surgeons are closely monitoring recent and upcoming shifts in federal healthcare policy, which significantly impact their practice management and financial sustainability. Increased tariffs and Medicare reimbursement cuts have heightened the cost of doing business, particularly affecting small and solo practices. Physicians are facing tighter margins as expenses for medical supplies and operational costs rise, prompting some to reconsider which procedures to offer.

The Centers for Medicare & Medicaid Services (CMS) is introducing the Transforming Episode Accountability Model (TEAM), a mandatory bundled payment system starting in 2026. This model covers 30-day surgical episodes, including lumbar fusions, and is driving surgeons to focus on cost transparency and standardized care pathways to reduce variability and waste in spine care. Risk adjustment in reimbursement models is being advocated to account for patient complexity.

Medicare payment reductions continue to pressure surgical specialties, pushing providers to seek alternative revenue streams and partnerships. Surgeons are encouraged to collaborate with hospitals and private payers to negotiate risk-sharing and value-based contracts that reward efficient, high-quality care. These contractual innovations are seen as critical adaptations to offset decreasing CMS reimbursements.

The current federal policy environment is characterized by unpredictability and influence from large healthcare stakeholders, including insurance companies and hospital systems. This dynamic complicates proactive planning and makes it challenging for small spine practices to maintain operational independence. Some surgeons are structuring their practices to minimize reliance on federal programs to preserve financial viability.

Additionally, increased oversight of surgical approvals and Medicaid funding shifts influence hospital operations and patient access to spine procedures. Larger facilities tend to absorb care for underinsured or uninsured populations, indicating a concentration of complex spinal surgeries in high-acuity centers. This trend reflects broader systemic pressures on spine care delivery in the United States.