The hidden costs of spine , orthopedic private practice

beckershospitalreview.com · Feb 21, 2026 · Collected from GDELT

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By: Carly Behm 6 hours ago Independent spine surgeons face some unique financial challenges that their employed peers might not encounter. On top of clinical work, independent spine physicians grapple with the costs of running a business and keeping up with margins. Spine physicians from different work settings discuss these factors. Editor’s note: Responses were lightly edited for clarity. Question: What financial pressure is most underappreciated by surgeons who don’t run their own practice? Douglas Beall, MD. Clinical Radiology of Oklahoma (Oklahoma City): The simple cost of doing business as compared to the amount of reimbursement over time is, in my opinion, the most underappreciated. A good example is Medicare reimbursement. The conversion factor is a dollar multiplier used by CMS to convert the total relative value units (RVUs) for a physician service into a Medicare payment amount. The original Medicare conversion factor in 1992 was about $31. If that were adjusted for inflation (using an inflation factor of 2.31), the conversion factor would be $71.61 ($31.00 × 2.31). The current conversion factor is $33.56 — less than half of what it would be if it were inflation-adjusted. Bottom line: reimbursement has largely stayed the same, while the cost to operate a practice has increased substantially. Philip Louie, MD. Virginia Mason Franciscan Health (Seattle): The mismatch between fixed overhead and declining per-case contribution margins. In employed models, surgeons rarely see the true operating margin of a service line. They don’t see the cost of unused block time, agency nursing premiums, supply chain inflation, or the compounding effect of small denials across thousands of cases (which are a huge administrative headache for all of us right now). But, these are the forces that will be shaping upcoming strategic decisions. Yes, we surgeons need a seat at that table. But, we need to do a better job of understanding the table itself. Vijay Yanamadala, MD. Hartford (Conn.) HealthCare: The hidden cost of administrative infrastructure required to satisfy payer requirements and ensure patients can actually access the care physicians recommend. Employed surgeons don’t see the armies of staff handling prior authorizations, peer-to-peer reviews, appeals, and documentation requirements that add zero clinical value but are essential for patients to receive treatment. These costs, ultimately passed to patients through higher premiums, exist because the system doesn’t trust physicians to make good decisions despite most of us entering medicine specifically to help people. There’s also underappreciation of how reimbursement cuts affect the ecosystem of care: when PT reimbursement drops, clinics close, and patients can’t access the conservative care we want them to have before considering surgery. The same applies to pain management and other alternatives. Surgeons are working within an environment where non-surgical alternatives are often unavailable or inadequate despite our best efforts to coordinate them. Christian Zimmerman, MD. St. Alphonsus Medical Group and SAHS Neuroscience Institute (Boise, Idaho):The current pressures for all physicians, health system employed or independent, are centered around the reimbursement schemas directed at complex care. The bundling/elimination of wRVUs for spinal procedures has resulted in marked decreases in reimbursements in the last decade. This intractable evolution has sequestered care to larger facilities and employed physicians typically capable of managing higher acuity patient populations. This decline is not isolated to surgical specialties, as all facets of care have receded availability and margin. Healthcare policy will soon be front and center as an action item longing for change. Next Up in Orthopedics Prior authorization delays and standardized codes that do not measure case variability are just two orthopedic policy disconnects surgeons say… With patient expectations higher than ever, orthopedic practices are looking to the integration of robotics within joint replacement surgeries and… The reimbursement structure and Medicare fee schedule in orthopedics and healthcare has slipped in recent years, leading to concerns from… Newsletter Join the 500,000+ healthcare executives who start their day with Becker’s