Guest Post from J. Todd Barnes, MBA, CMPE
Administrator Dept.’s of Neurology and Neurosurgery
University of Oklahoma Health Sciences Center
Given the quantum changes that are happening to the healthcare system in the United States, there has never been more of a need for quality data in almost every facet of neurological surgery. Public and private insurers want to add quality into the payment calculation, rather than paying for quantity only. Hospitals and healthcare systems are rapidly consolidating in an attempt to position themselves to compete in the new world of accountable care organizations and patient centered medical homes. Consumers are demanding more information about the quality of care they are receiving. To this end, the U.S. Department of Health and Human Services (HHS) is attempting to measure quality with its CAHPS program, though it centers on the patient experience and has little to do with the actual quality of the care provided. HHS has also launched programs like Physician Compare and Hospital Compare, but these too fail to give neurosurgical patients useful information about neurosurgical quality. The uncertainty of the future has also pushed many physicians to the safety of employment whether by a hospital or a physician group. Practices will have to figure out how to survive in both the fee-for-service reimbursement world while transitioning to the post-ACA era of value-based contracting and bundled payments. The need for quality data exists whether to measure the quality of surgical outcomes, or to formulate a fair physician compensation package, or even to help assess the fair market value of emergency room call coverage provided to a healthcare facility.
The great news is that neurosurgery is proactively meeting these challenges. On the quality front, the NeuroPoint Alliance has developed the National Neurosurgery Quality and Outcomes Database (N2QOD). The database is the first national risk-adjusted quality and outcomes database for organized neurosurgery, and though only having been in existence for a little more than two years, it is showing great promise in validating procedures as well as helping predict and explain possible outcomes of surgeries to help educate patients. The quality and outcomes database is in constant development so as to include as many conditions as practical. The database started with the lumbar spine module, and has since grown to include the cervical spine. In the coming months, a vascular and spinal deformity module will also be available to participating sites.
For socio-economic data, there are several sources that are used to gather information about salary, call pay, and productivity just to name some of the popular data points. All of the socio-economic surveys listed below are filled out voluntarily by the participants and thus none are more or less valid, although that argument is sometimes used to try to discredit survey results. Each of the surveys listed below ask some of the same questions, though the definitions may differ slightly and due to these differences the data collected does not always yield the same endpoints. There are companies like the consulting firm of Sullivan Cotter that predominantly surveys hospitals and health systems for both salary and call pay information. Another player in the physician survey arena is the Medical Group Management Association (MGMA). This group surveys both private and academic groups separately for salary and productivity. They survey all practices for call pay, practice cost, and medical directorship information. The largest neurosurgery socio-economic survey with the most surgeons represented in one comprehensive survey is produced by the Neurosurgery Executives’ Resource Value and Resource Society (NERVES). The NERVES organization is made up primarily of administrators and managers of neurosurgery practices across the United States. The NERVES survey is in its 11 year of publication, and is strictly focused on the practice of neurosurgery. There are at times large differences in the data on the surveys previously mentioned, though sometimes explainable, usually end up with each side in the negotiation choosing the survey that is most advantageous to their position. Compensation and call pay tend to be the most used and disagreed points when using surveys. The trauma call stipend in the graph below shows some of the variation that has existed, though the numbers are moving closer over the years.
Whether data is related to quality or cost, going forward the need for quality data will only increase as the cost to provide healthcare keeps rising, and the dollars to pay for the increases become fewer. In the future it will be imperative for quality data, and provider participation to help obtain that data. If the collection is left to third parties, then the outcome may be inaccurate and unfavorable.