Neurosurgery: Economics &
Politics
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.
Neurosurgical Vendors
Revised: 2/9/07
Text
Copyright 2007