Becker’s Healthcare Podcast The Price of Silence and the Future of Spine Surgery with Dr. Morgan Lorio
Jan 31, 2026
Dr. Morgan Lorio, orthopedic spine and hand surgeon and past president of the International Society for the Advancement of Spine Surgery, digs into declining reimbursement and policy shifts reshaping spine care. He explores consolidation’s threat to independent practice. He outlines concerns about valuation, efficiency adjustments, access barriers, and what reform should prioritize.
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Structural Reimbursement Decline
- Medicare reimbursement for common spine procedures fell about 34% (inflation-adjusted) since 2000, reflecting structural change not cyclical pressure.
- Policy-driven budget neutrality shifts costs onto surgeons and quietly shrinks system capacity.
Efficiency Is Masked Attrition
- CMS budget neutrality assumes a fixed pie so any increases are offset by cuts elsewhere, often procedural medicine.
- Framed as 'efficiency', these policies produce systematic attrition rather than real performance gains.
Time Cuts Ignore Cognitive Load
- CMS is assuming efficiency gains without observing clinical practice, counting reduced time but not increased intensity.
- Surgeons absorb the increased cognitive and technical workload when time metrics fall.
