The Price of Silence and the Future of Spine Surgery with Dr. Morgan Lorio
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What is the main topic discussed in this episode?
This is Carly Beam with the Becker Spine and Orthopedics Podcast, and I'm thrilled to be joined today by Dr. Morgan Lorio, a spine surgeon and past president of the International Society for the Advancement of Spine Surgery. He's been keeping a close eye on all the latest policy shifts happening in healthcare and specifically how they relate to spine care. So I'm really excited to discuss with him today. Dr. Lorio, thank you so much for being here.
Thank you for having me, Carly.
So before we kick things off, if you could just introduce yourself and share a little bit more about your background.
I'm Morgan Lurio. I'm an orthopedic spine and hand surgeon. I've been working for decades now with ISAS, chairing their coding and reimbursement task force, and very much involved with what's happening in policy nationally.
Great.
How are reimbursement policies impacting spine surgery?
And today we're discussing your recently submitted analysis titled, The Price of Silence. And this takes a really hard look at reimbursement policy, consolidation, and the future of spine surgery as a whole. To start off, can you just tell me about what compelled you to write this? Okay.
Well, this piece was written out of necessity, not theory. In other words, I felt compelled to break a silence that policy has enforced for years. I should also say this clearly at the outset that this article, which is now in press at the International Journal of Spine Surgery, was authored in part as a direct response to the Senate Health Committee's current request for input on AMA CPT codes. I felt it was important that this analysis exist in the public record while those discussions are actively underway now. Over the last 20 years, spine surgeries experienced a quiet but relentless devaluation of physician work, and the data now make that undeniable. Add the pandemic as an accelerant, and what we're seeing isn't cyclical pressure, it's structural transformation.
What factors are driving the decline in physician autonomy?
I wrote this as a surgeon, not as an economist, someone who lived through COVID, nearly died from it, and woke up to a profession that no longer resembled the one I entered.
Yeah, and in your paper, you cite this nearly 34% inflation-adjusted decline in Medicare reimbursement for some of the most common spine procedures since 2000. Can you talk more about what's driving this erosion?
Certainly. Well, the short answer is budget neutrality without reality testing. When CMS insists that the pie is fixed, any upward adjustment must be offset elsewhere, often from procedural medicine. Budget neutrality doesn't control cost. It just decides who absorbs them. Surgeons, unfortunately, are the scapegoats. There's been no meaningful cost-of-living adjustment since 2001, while practice costs have risen more than 60%.
Why is the concept of efficiency in healthcare misleading?
What's framed as efficiency is, in practice, systematic attrition. What's being sold as efficiency, cost savings, streamlining, optimization, modernization, has the real effect of gradually eliminating people, capacity and function, rather than genuinely improving performance. It doesn't make the system work better. It makes the system smaller by quietly wearing it down. In this case, efficiency is just attrition with better branding. Rome didn't collapse from lack of manpower. It collapsed when experience was replaced with cheaper substitutes. That's not efficiency. That's slow institutional decay.
Yeah.
What is the significance of the vanishing independent surgeon?
And you're kind of hooking on what you're saying about efficiency. I know you are particularly critical about CMS's 2026 efficiency adjustment. Can you just kind of dive in deeper on why that's such a red flag?
Yeah, well, because it breaks a foundational assumption This is something we surgeons were taught and made to believe, that physician work equals time times intensity. CMS is now assuming efficiency gains without observing actual clinical practice. Spine surgery, meanwhile, is becoming more complex. We have older patients with more morbidities, and we're using minimally invasive techniques that require higher cognitive load. When time goes down and intensity goes up, only the time gets counted now and the surgeon eats the rest.
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Chapters
8 chapters
1
What is the main topic discussed in this episode?
0:00–0:52
2
How are reimbursement policies impacting spine surgery?
0:52–2:08
3
What factors are driving the decline in physician autonomy?
2:08–3:11
4
Why is the concept of efficiency in healthcare misleading?
3:11–4:00
5
What is the significance of the vanishing independent surgeon?
4:00–4:57
6
How does CPT governance affect frontline surgeons?
4:57–5:38
7
What are the implications of coverage without care for patients?
5:38–6:43
8
What meaningful reforms are necessary for the future of spine surgery?
6:43–13:19
Speakers
2 identifiedMore from Becker’s Healthcare -- Spine and Orthopedic Podcast
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