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William T. Couldwell, MD, is editor of the AANS Bulletin He is professor and Joseph J. Yager Chair of the Department of Neurosurgery at the University of Utah School of Medicine |
In the cover story, Rahimi and colleagues document the implementation of a patient-centered care plan at the Medical College of Georgia. They describe an institution-wide initiative, and for nearly two years following its implementation in 2003 they tracked measurable outcomes based on patient satisfaction and length of stay. Following the studied period they noted an increase in neurosurgical admissions, a statistically significant increase in patient satisfaction, and decreased length of stay.
The maintenance costs for hospital beds increased commensurate with the increase in neurosurgical admissions during the period studied. One would expect the contribution margin to the hospital from neurosurgical admissions also to have increased significantly during this period.
Neurosurgeons should be aware of the importance of neurosurgical admissions to the fiscal health of the hospital. The combination of rising neuroscience volumes and continued strong margins has led some hospital administrators to determine that “the brain is the new heart,” according to one hospital CEO whose facility is among a number expanding its neuroscience service line (5). This expansion is at a time when traditional volume drivers such as orthopedics and cardiology/cardiac surgery are threatened by reimbursement cutbacks and non-hospital competitors.
The most frequent neuroscience procedures such as stroke care and spinal and cranial surgery offer comparable or superior margins to these services. For example, the average per-patient contribution profit in 2002 for neurosurgery, $9,893, significantly outpaced per-patient profits for general surgery ($7,491), thoracic surgery ($6,341), vascular services ($4,718) and spinal procedures ($2,599). Furthermore, the total neurosurgical inpatient and outpatient volumes are expected to increase significantly as the U.S. population ages (4). Between 2004 and 2014 projected increases in national volumes are 10 percent for cerebrovascular services including stroke and aneurysm, 14 percent for spinal surgeries, and 26 percent for neurodegenerative diseases (3).
The Rahimi article clearly demonstrates the benefits of a coordinated effort for patient-centered care in neurosurgery. Neurosurgical outcome studies, generated both within the specialty and externally by governmental, hospital and insurance entities, increasingly will be incorporating measures of patient satisfaction. This will represent something of a shift from the “silo” mentality of traditional departmental structure in most institutions. Neurosurgical practitioners of the future must successfully engage in a patient-centered, collaborative environment. Collaboration in the form of multidisciplinary management and partnering with the hospital and allied services to improve patient care (and the bottom line) will be the hallmarks of the successful neurosurgical practices of the future (1).
Socioeconomic Research in the AANS Bulletin
The article by Rahimi and colleagues is one of several peer-reviewed articles published in the AANS Bulletin in the last two years. Presenting reliable information on socioeconomic topics to readers is a vital interest of the Bulletin and the AANS. By introducing a rigorous peer-review process and providing a definitive venue for publication, the Bulletin seeks to promote research into socioeconomic topics.
The mission of the Bulletin is to provide socioeconomic, professional and association information to AANS members and to serve as the primary socioeconomic and professional publication for the neurosurgical community. The participation of a broad cross section of researchers and authors inside and outside of the specialty therefore is necessary and desired.
I invite you to review the Bulletin’s writing guidelines, available from the Bulletin’s home page, www.aans.org/bulletin, and to consider submitting an article that will add to neurosurgery’s body of knowledge in socioeconomic areas.
References
1. Black PM: Challenges in contemporary academic neurosurgery. Neurosurgery 58:419–425, 2006
2. Farley FA, Weinstein SL: The case for patient-centered care in orthopaedics. J Am Acad Orthop Surg 14:447–451, 2006
3. Considerable margins and continued growth spur interest in neuroscience. Future of Neurosciences. Health Care Advisory Board, 2005
4. Neuroscience: service line offers untapped clinical volumes. Clinical Strategy Watch. The Advisory Board Company. Washington, D.C., September 2006
5. Zuckerman and Markham, HFM, June 2006; Shellenbarger, Grand Rapids Press, Feb. 19, 2006.