ASM

[PinchandBurn]

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what are we in private going to do ?

This seems like it would also hit the employed docs too as this becomes "portable' from job to job....

CMS shifts Medicare risk to spine, orthopedic surgeons - Becker’s Spine Review

For two decades, the financial risk in Medicare’s value-based experiments landed on institutions. Hospitals took on the bundles. Accountable care organizations absorbed the shared savings and the shared losses. The individual surgeon mostly kept billing fee-for-service and let the layer above...

www.beckersspine.com

 

[Laryngospasm]

Looks like Tylenol and home exercises for everyone

Also hard to figure out exactly what to make of this.. anyone know how the score is added up?

 

[willabeast]

Wonder how AI fits into this.

 

[mille125]

Looks like Tylenol and home exercises for everyone

Also hard to figure out exactly what to make of this.. anyone know how the score is added up?

nobody knows for sure.....

The only way to fight is if the collective limits Medicare patients (which wont happen)

 

[mille125]

what are we in private going to do ?

This seems like it would also hit the employed docs too as this becomes "portable' from job to job....

CMS shifts Medicare risk to spine, orthopedic surgeons - Becker’s Spine Review

For two decades, the financial risk in Medicare’s value-based experiments landed on institutions. Hospitals took on the bundles. Accountable care organizations absorbed the shared savings and the shared losses. The individual surgeon mostly kept billing fee-for-service and let the layer above...

www.beckersspine.com

It hits everyone

 

[bubaghanush]

There is another thread on this.

B

Post in: 'CMS proposes new mandatory ambulatory specialty model (low back pain)'

Apr 24, 2026

Any of you in a position where you are selected but spine surgeons who work in your office were not?

second the sentiment: WTF are we supposed to do? I read into this model and the way it works is that you absorb the costs and medical decision making of those upstream that referred to you as well as those downstream if you refer to surgeon in future as long as your collections is >30% of the episode summary.

How do we avoid a negative reimbursement especially if you are the only person in a group with spine surgeons and other pain physicians who are impacted?

Any one else...

• bubaghanush

You can look up your name to see if you're included on the lucky list. I am. I haven't checked in a couple of months, but I thought they were going to release more guidance toward the end of 2026.

I posted a table describing the four categories and how they're reported. Basically more BS paperwork, more questionnaires.

 

[Laryngospasm]

Seems like a lose lose.. spend too much money.. we cut reimbursement, lack of improvement, we cut reimbursement. So you must get higher than average improvement in function while spending no money.
Also by definition a third or so of people will see cuts even if we all do our best which may paradoxically encourage everyone to see more patients even quicker and lower the floor for care even more.
Thirdly mid levels not included.. so if they are in your clinic and ordering injections how is this accounted for?
And lastly is your score tied to your surgeon/s? If so only those with very conservative surgeons will do well.

 

[PinchandBurn]

There is another thread on this.

B

Post in: 'CMS proposes new mandatory ambulatory specialty model (low back pain)'

Apr 24, 2026

Any of you in a position where you are selected but spine surgeons who work in your office were not?

second the sentiment: WTF are we supposed to do? I read into this model and the way it works is that you absorb the costs and medical decision making of those upstream that referred to you as well as those downstream if you refer to surgeon in future as long as your collections is >30% of the episode summary.

How do we avoid a negative reimbursement especially if you are the only person in a group with spine surgeons and other pain physicians who are impacted?

Any one else...

• bubaghanush

You can look up your name to see if you're included on the lucky list. I am. I haven't checked in a couple of months, but I thought they were going to release more guidance toward the end of 2026.

I posted a table describing the four categories and how they're reported. Basically more BS paperwork, more questionnaires.

Thanks for the template box.

Did claude make that? SO if we screen folks and document that and they dont go to the ED, looks like we are good...agreed its BS.

 

[BobBarker]

There is too much nuance to the practice of medicine. Grandma falls and her back hurts among other issues and they don’t want her to go the ED?

How often does someone go to the ED and simply say “I’m here because my back hurts. It is my chronic back pain, but worse than normal” in the Medicare population? I know the Medicaid people do it, the commercial ones do if their spouse is worried but after the first time, and they get the bill, they stop doing it.

 

[Ducttape]

im sorry.... but dont your 2 statements contradict each other?



noone is going to tell grandma not to go to ER but grandmas on Medicare go to ER all the time because her back pain hurts more than usual.

 

[BobBarker]

I’m saying for back pain unrelated to a fall. See.. it is all too nuanced to be implemented fairly.

 

[Ducttape]

the medicare population might do it as much as any other population, maybe more, because they know that it will get covered to some degree. especially if they have supplemental coverage.

i believe more people without insurance or with high deductibles just give up, never go to ER to face bankruptcy, and try alternative out of pocket therapies such as chiro or laser or spinal decompression or shockwave or whatever is being marketed.


i do agree that strict rules may not be implemented fairly. in fact, i daresay mostly they are not.

 

[mille125]

I’m saying for back pain unrelated to a fall. See.. it is all too nuanced to be implemented fairly.

My Medicare population seems to go to the ER at a rate equal to my other patients.

 

[Malayil]

It’s based off of your TIN. So if you’re in a multi specialty group hospital based group or academic group under the same TIN then that SPINE surgeon, ER visit, injection etc. to get triggered as a whole

If you’re in a private practice, single TIN without SPINE surgeons then your cost are based off of what you did/do

 

[bubaghanush]

Thanks for the template box.

Did claude make that? SO if we screen folks and document that and they dont go to the ED, looks like we are good...agreed its BS.

Claude made it, yes. There wasn't a whole lot of detail when I looked a few months ago, at the time it said more guidance would be coming.

I'm in an academic group and I sent it out. Leadership and admin did not respond. I get the feeling they won't react until the first set of negative reimbursement hits in a couple years.

 

[PinchandBurn]

Claude made it, yes. There wasn't a whole lot of detail when I looked a few months ago, at the time it said more guidance would be coming.

I'm in an academic group and I sent it out. Leadership and admin did not respond. I get the feeling they won't react until the first set of negative reimbursement hits in a couple years.

Urghhh


Thanks buddy