Neurosurgery:
Economics & Politics
American Association of Neurological Surgeons
·
Founded 1938.
·
Harvey Cushing Society, founded 1932
·
Neurosurgical Society of America, founded 1948
Congress of Neurological Surgeons
·
Founded in 1950 for younger neurosurgeons, excluded from the older
societies
·
Limits its leadership to 45 years or younger
·
“Fifty Years of the CNS”, Barrow DL N8/00
Society of Neurological Surgeons
·
Established in 1920
ER Coverage
·
See “Emergency Room Coverage, What Every Neurosurgeon Should Know”
by the AANS/CNS Joint Section on Neurotrauma and
Critical Care
·
One
in five neurosurgeons in the
·
Neurosurgeons
are expected to take call as a condition of medical staff membership.
·
EMTALA
regulations dictate that specialty availability on a hospital call schedule
must extend to the hospital Emergency Department (ED), obligating medical staff
to trauma call.
·
57%
of all high-acuity trauma patients have some neurologic injury, and half of the
150,000 injury-related deaths that occur annually in the
·
Neurotrauma
contracts:
o
Transfer
agreements are ideally worked out in the context of a state or regional trauma
system and should include predefined criteria to avoid EMTALA violations.
o
Specifically
dangerous to the institution is any implication that a neurosurgeon who contracts for trauma coverage is compelled to bring
elective work to the hospital. Major regulatory concerns have arisen over these
antikickback “payment for referral” issues, and
hospital systems have been made to pay considerable fines and have undergone
substantial federal scrutiny for such schemes.
o
Estimating
fair market value is critical. The best yardstick may be local or regional data
as long as demographics, average Injury Severity Scores, and the like are
comparable. These figures are difficult to come by, and large regional and
demographic variability is likely to exist. National figures will reflect reimbursement
methodology for similar institutions more broadly, but such data compilations
are likewise not widely available. The Council of State Neurosurgical Societies
(CSNS) has recently completed a national Internet survey on key socioeconomic
parameters of emergency neurosurgery and neurotrauma.
o
Neurosurgeons
and their hospitals have developed a variety of creative arrangements for
making trauma coverage both fiscally and physically responsible. Smaller
community hospitals with a limited number of neurosurgeons have worked out
cross-coverage arrangements, periodic locum tenens, or temporary transfer
agreements to shield their neurosurgeons from the burden of excessive call
requirements. Hospitals may bill patients directly and reimburse a guaranteed
percentage of the neurosurgeon’s trauma receivables or simply provide billing
services for the neurosurgeon. Hospitals may supply oncampus
office space to allow for ready neurosurgical availability. Since neurotrauma coverage is widely perceived as increasing
exposure to medicolegal liability, some institutions
have agreed to pay for additional malpractice coverage and, in some cases,
cover the entire amount. "Neurotrauma
Director" positions may be created for neurosurgeons most involved in
program development, along with a negotiated annual consulting fee.



Revised:
2/9/07
Text
Copyright 2007