Whats the Top Concern for Neurosurgeons in the Next One to Five Years

Medicare Reimbursement

Random Sample, a new, regular feature of the AANS Neurosurgeon, engages AANS members to assess their views on a topic of current interest.

In late August, the AANS Neurosurgeon asked members of the AANS who are practicing neurosurgeons to select the most critical healthcare issue for neurosurgeons in the next one to five years. The top concern, Medicare reimbursement, was selected by 35 percent of respondents. Medical liability reform ranked second, (24 percent), followed by uninsured and underinsured patients (21 percent). Unfunded mandates (10 percent) ranked a distant fourth, followed by “other” (four percent) and then workforce— defined as the ratio of practicing neurosurgeons to patients—and research funding, which were tied at 3 percent.

When asked to rank each concern by severity, medical liability reform (68 percent) outranked Medicare reimbursement (63 percent) as a “critical” concern, followed by uninsured and underinsured patients, which was selected as a critical concern by 49 percent of respondents (see table). “Important” concerns included unfunded mandates (49 percent), research funding (44 percent) and workforce (41 percent). Half of respondents said that electronic medical records were of some concern.

Each Issue Ranked by Severity

Survey participants were given the opportunity to comment on what they believe are the most pressing issues, and 29 percent did so. Signed responses follow.

• When the largest “insurer” for healthcare services, Medicare, only pays physicians pennies on the dollar, it becomes essentially pro bono work. The private insurers have seen that Medicare has gotten away with paying physicians an absurdly low amount so they have been following suit. In this environment, neurosurgeons will not survive unless they have access to the more generously reimbursed facility fee. The noose is tightening around the neck of the neurosurgeon in private practice.
  —Matthew Ross, MD, Wheaton, Ill.

• While workforce issues are significant, they are exacerbated by the continuing escalation of unfunded mandates and excessive documentation. As the amount of paperwork continues to expand, the time each physician has to care for patients continues to shrink. I find that I need to spend an additional two hours or so per day completing “documentation.” This continues to expand my day well into the evening and nighttime hours. I am faced with the option of seeing fewer patients, or accelerating my impending burn-out. What I find the most irritating and inflammatory about this is that most of this “documentation” and “quality measure reporting” is bogus. The issue of liability reform remains the elephant in the room. I continue to be amazed that this major factor in waste in healthcare dollars due to defensive medicine continues to be ignored.
  —Monica C. Wehby, MD, Portland, Ore.

Methodology and Demographics
Randomly selected neurosurgeon members with e-mail addresses were asked to participate in this online survey. Residents and fellows were not included in the pool surveyed. Invitations were successfully sent by e-mail to 299 individuals, and 68 neurosurgeons participated in the survey for a response rate of nearly 23 percent. Most respondents were between the ages of 46 and 55 (40 percent), followed by those in the age ranges of 56 to 65 (31 percent), 35 to 45 (22 percent), 66 and older (6 percent) and under 35 (1 percent). Most respondents were in full-time academic practice (35 percent) followed closely by those in private practice (34 percent). Other respondents were in private practice with academic affiliation or appointment (15 percent), hospital employees (12 percent), or other (4 percent). No respondents were employees of the federal government.

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