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Cross-Post: ‘No other industry would tolerate this’: The problem with prior authorization in spine surgery

By Cross Post, Prior Authorization, Spine CareNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting to items from other places that we believe will interest our readers. Today’s post originally appeared in Becker’s Spine Review on Sept. 25. Neurosurgeons Anthony M. DiGiorgio, DO, MHA, FAANS; Praveen V. Mummaneni, MD, FAANS and Luis M. Tumialán, MD, FAANS discuss prior authorization and the significant problems physicians face when it comes to receiving fair payments for services offered.

Denial of payment after prior authorization has become a grim reality in American health care. Insurance companies authorize procedures, and surgeons perform them as approved. Then, the insurance company denies payment. The authors state, “No other industry would tolerate this system. Yet, in healthcare, physicians, bound by their oaths to care for patients, endure a system that withholds payment.”

Ultimately, patients bear the brunt of this charade. The authors conclude the article by stating that patients deserve insurance companies that fulfill their contractual obligations.

Click here to read the full article.

We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #FixPriorAuth.

October 6, 2023
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Cross-Post: Improving Health Care Quality Measurement to Combat Clinician Burnout

By Burnout, Cross PostNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting to items from other places that we believe will interest our readers. Today’s post originally appeared in Journal of the American Medical Association (JAMA) on Sept. 1. Neurosurgeon Anthony M. DiGiorgio, DO, MHA, FAANS, Jesse M. Ehrenfeld, MD, MPH and Brian J. Miller, MD, MBA, MPH discuss the impacts and causes of burnout, which affects up to two thirds of physicians.

Although the causes are multifactorial, the authors state that one of the key causes for clinician frustration is quality metrics. Administrative burdens from poorly designed systems and ineffective regulatory policies are central to clinician frustration. Improving these metrics could reduce clinician burnout, with studies indicating that physicians spend less than 15% of their day in direct patient contact. “A living system of quality metrics with a ceiling on their quantity, as well as a metric life cycle with continuous assessment and improvement, would significantly reduce burdens on clinicians and administrators alike” according to DiGiorgio et al.

Click here to read the full article in JAMA.

We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery.

September 7, 2023
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Cross-Post: A Pediatric Neurosurgeon Reflects on His Job and the Post-Roe Landscape

By Cross Post, PediatricsNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places that we believe will interest our readers. Today’s post originally appeared in NPR’s Fresh Air on July 28. Dave Davies interviews pediatric neurosurgeon John “Jay” Wellons, III, MD, FAANS, about his memoir “All That Moves Us,” which reflects on his experiences operating on children facing critical illnesses and injuries.

Dr. Wellons relays the story of a 9-year-old pediatric patient in an auto accident in Alabama who had a blood clot pushing her brain. Due to the weather, medevac helicopters weren’t running. Dr. Wellons recounts he arranged for a military Blackhawk to bring her to Birmingham, Ala., for surgery. The surgery was successful, according to Dr. Wellons, “The flicker of the eyes open – that’s a miraculous feeling, Dave, you know, to see somebody wake up after something like that.”

Dr. Wellons also describes an operation on a fetus in the womb, the spine he describes as the size of three grains of rice stacked together. This was surgery to correct a condition that leads to spina bifida.

When asked what he thinks will happen in the post-Roe landscape, Dr. Wellons states, “I can’t tell you how much I think that this ruling is going to affect what it’s like for families to have these substantial — neurologic, cardiac, urologic — encephaloceles where the gut’s outside the body that is hard to be fixed sometimes. Like, we’re going to see a lot more of these now, and we’re going to have to, as a society, understand that we’re going to have to take care of these children. That’s our job. So, yes, I think it’s going to have an impact.”

Click here to access the full interview.

We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery.

August 7, 2023
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Cross-Post: Surgery Decreases Nonunion, Myelopathy, and Mortality for Patients With Traumatic Odontoid Fractures: A Propensity Score Matched Analysis

By CNS Spotlight, Cross PostNo Comments

From time to time on the Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they may interest our readers. Today, we wanted to bring attention to a recent publication in Neurosurgery, the official journal of the Congress of Neurological Surgeons, which provides multimedia, prompt publication of scientific articles on clinical or experimental surgery topics important for the brain, spine, and peripheral nerves, reviews, and other information of interest to readers across the world.​ The article — “Surgery Decreases Nonunion, Myelopathy, and Mortality for Patients With Traumatic Odontoid Fractures: A Propensity Score Matched Analysis” — is published as part of Neurosurgery’s High-Impact Manuscript Service (HIMS).

Published online on June 13 and expected in the September issue of Neurosurgery, the article addresses odontoid fractures, common in elderly patients after a low-energy fall. “Given the increasing incidence of odontoid fractures with the aging population, we believe our findings could assist with neurosurgical decision-making for an increasingly common and complex problem,” the researchers say.

According to the Wolters Kluwer press release, “Michael B. Cloney, MD, MPH, of the Department of Neurological Surgery at Northwestern University in Chicago, and colleagues have published evidence that surgery should be considered the initial approach for many patients. Compared with nonoperative approaches to treatment, surgical stabilization of the fracture was associated with less myelopathy (mobility impairment due to spinal cord damage), and lower rates of fracture nonunion, 30-day mortality, and one year mortality.’”

To read the full Neurosurgery article, click here.

Editor’s Note: We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and @NeurosurgeryCNS and using the hashtag #neurosurgery.

July 17, 2023
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Cross-Post: A new crisis at the border: Traumatic injuries caused by falls from Trump’s 30-foot wall

By Cross Post, Spine Care, TraumaNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other publications that may interest our readers. Today’s post was first published in The Hill on July 6, titled “A new crisis at the border: Traumatic injuries caused by falls from Trump’s 30-foot wall.” In the op-ed, Alexander Tenorio, MD, a neurological surgery resident at the University of California San Diego, discusses the injuries and economic burden of height extensions of U.S.-Mexico border wall barriers.

“As a physician, it is my duty to reveal this unnecessary harm and strain on hospital resources. As the son of Mexican immigrants, it is my duty to continue to fight for this vulnerable population,” states Dr. Tenorio.

Dr. Tenorio recently joined human rights leaders as the physician representative to brief members of Congress and President Biden’s domestic policy advisors on the public health crisis occurring at the U.S.-Mexico border.

Click here to read the op-ed.

Editor’s Note: We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #neurosurgery.

July 7, 2023
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Cross-Post: When Insurance Fails

By Cross Post, Health Reform, Prior AuthorizationNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places that may interest our readers. Today’s post originally appeared in The Lincoln Journal Star, titled “When Insurance Fails.” In the op-ed, neurosurgeon Jeremy Hosein, MD, discusses the misuse of prior authorization, which delays care, prolongs suffering and adds significant administrative costs to health care.

Dr. Hosein relays a story of a 47-year-old female with nagging pain in her hip who was sent by her primary doctor to physical therapy and given pain medicine. When the pain persisted and caused difficulty walking, she was referred to an orthopedic surgeon who ordered an MRI. The insurance company denied the MRI, stating that the scan was not medically necessary and that she had not yet completed physical therapy. Her orthopaedic surgeon appealed the denial, and the MRI was eventually performed nearly six weeks later. Her cancer doctors said she could have avoided surgery had the tumor been discovered only weeks earlier.

According to Dr. Hosein, prior authorization is increasingly being used to deny or delay basic medical care such as blood tests, imaging and other medically necessary procedures. A 2023 Kaiser Family Foundation analysis found that 82% of appeals in Medicare Advantage resulted in overturned denials. Fortunately, some hope may be on the horizon, states Dr. Hosein. The Centers for Medicare & Medicaid Services issued rules to reduce the burden of prior authorization with an automated electronic process and to add transparency to the process.

Click here to read the op-ed and here to read more about CMS’ proposed rules.

Editor’s Note: Organized neurosurgery aims to protect patients’ timely access to care by streamlining the prior authorization process. Patients experience significant barriers to medically necessary care due to prior authorization requirements for items and services that are eventually routinely approved. In the 2023 Legislative & Regulatory Agenda, the American Association of Neurological Surgeons and the Congress of Neurological Surgeons outline health policy action items the neurosurgical societies plan to advance with Congress and the Biden Administration.

We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #FixPriorAuth.

May 25, 2023
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Cross-Post: Ending the Health Insurance Monopoly Will Make Life Healthier for Alabamians

By Access to Care, Cross Post, Health ReformNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places that may interest our readers. Today’s post originally appeared on 1819 News on April 21, titled “Ending the Health Insurance Monopoly Will Make Life Healthier for Alabamians.” In the op-ed, Richard P. Menger, MD, MPA, assistant professor of neurosurgery and political science at the University of South Alabama in Mobile, Ala., discusses why broadening health insurance coverage options in Alabama will improve the state’s health care system.

Alabama is tied with Alaska as the least competitive insurance market in the nation, limiting patient options, hurting hospitals and physicians and feeding the insurance industry. Lack of competition also impacts prior authorization, a system where insurance companies must approve certain surgeries before they agree to pay for them, despite the physician and patient deciding upon a personalized treatment plan. Dr. Menger states that this is an intentional delay tactic, and the cumbersome apparatus frustrates families, hurts patients and burns out physicians.

Dr. Menger argues that the arc of reform needs to bend towards the injection of competition between and within state lines — With that will come better products, lower prices, higher quality and more innovation.

Click here to read the full op-ed by Dr. Menger.

Editor’s Note: Organized neurosurgery aims to improve competition in the health care system by broadening health insurance coverage options, increasing scrutiny of hospital and other health care consolidation, removing restrictions on physician ownership of hospitals and other ancillary services and establishing network adequacy standards.

We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery.

May 9, 2023
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Cross-Post: Stereotactic Radiosurgery for Vestibular Schwannoma in Neurofibromatosis Type 2: An International Multicenter Case Series of Response and Malignant Transformation Risk

By CNS Spotlight, Cross PostNo Comments

From time to time on the Neurosurgery Blog, you will see us cross-posting or linking to items from other places that we believe will interest our readers. We wanted to bring attention to a recent publication in Neurosurgery, the official journal of the Congress of Neurological Surgeons.​ The article, “Stereotactic Radiosurgery for Vestibular Schwannoma in Neurofibromatosis Type 2: An International Multicenter Case Series of Response and Malignant Transformation Risk” was published as part of Neurosurgery’s High-Impact Manuscript Service (HIMS).

Published in the May issue of Neurosurgery, the article is a retrospective study conducted by an international, multicenter team. Lead author Hussam Abou-Al-Shaar, MD of the University of Pittsburgh Medical Center in Pittsburgh, Pa. and colleagues reviewed data from 12 surgical centers around the world and a total of 267 patients with 328 vestibular schwannomas who underwent stereotactic radiosurgery. They found that stereotactic radiosurgery is effective while preserving serviceable hearing and not causing radiation-related tumor development or malignant transformation.

According to the Wolters Kluwer press release, “Dr. Abou-Al-Shaar’s group concludes that their results point to the need for early treatment of vestibular schwannoma in patients with [neurofibromatosis type 2]. ‘Tumor volume appeared to significantly impact tumor control and freedom from additional treatment, advocating for early stereotactic radiosurgery to maximize benefits and delay clinical deterioration.’”

To read the Neurosurgery article, click here. The complete May issue is here.

Editor’s Note: We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and @NeurosurgeryCNS and using the hashtag #neurosurgery.

May 1, 2023
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Cross-post: As a Neurosurgeon, I See the Devastating Toll of the Raised Border Wall

By Cross Post, Spine Care, TraumaNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places that may interest our readers. Today’s post originally appeared in the Los Angeles Times on April 13, titled “Opinion: As a San Diego neurosurgeon, I see the devastating toll of the raised border wall.” In the op-ed, Alexander Tenorio, MD, a neurological surgery resident at the University of California San Diego, poignantly discusses the horrific spinal cord and brain injuries caused by falls from the border wall.

Dr. Tenorio relays stories of patients coming to the emergency department with serious injuries, such as a 30-year-old male with an unstable spinal fracture after falling off the border wall. The patient had a severe spinal cord injury. Dr. Tenorio “walked over to the trauma unit and saw the terrified young man, lying immobile with a collar supporting his neck. Instead of concerned family, he was surrounded by Border Patrol officers.”

Since the height of the border wall in San Diego was raised in 2019, there have been a record number of traumatic spinal injuries sustained in border falls. Dr. Tenorio can attest to the unnecessary human suffering the higher wall imposes on people. As the son of Mexican immigrants who crossed the same border in the 1980s when fleeing violent threats in their hometown, Dr. Tenorio understands that his patient’s life story could easily have been his or his parents’.

Dr. Tenorio concludes the op-ed urging political leaders to halt the planned border wall extensions and provide greater resources for hospitals serving border regions.

Click here to read the op-ed.

Editor’s Note: We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery and using the hashtag #neurosurgery.

April 14, 2023
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Cross-Post: Alabama Hospitals Need Competition

By Advocacy Agenda, Cross Post, Health ReformNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places that may be of interest to our readers. Today’s post originally appeared on AL.com on March 17, titled “Guest opinion: Alabama hospitals need competition” In the op-ed, Richard P. Menger, MD, MPA, assistant professor of neurosurgery and political science at the University of South Alabama in Mobile, Ala., discusses why the “game of Hospital Monopoly needs to end.”

Alabama is facing a crisis regarding hospital operating costs. Alabama hospitals posted a 79% decrease in operating margin from 2019-2022, putting rural hospitals at risk for closure. Total hospital expenses have increased by $2.6 billion from pre-pandemic levels, with Alabama hospitals spending 30% more on labor in 2022 than in 2019.

Dr. Menger argues that reform needs to break up the large hospital system mergers, acquisitions and consolidation. “This is destroying competition, limiting care options for patients, and burning out our physician and nurse workforce,” according to Dr. Menger. The solution requires reform, accountability and competition.

  • The first solution is to reduce the administrative bloat of health care. Hospital executive salaries have far outpaced any physician salary increase, and reform needs to focus on the patient and the physician.
  • The second solution is holding non-profit hospitals accountable when they receive government monies. Due to market consolidation, large hospital systems are everywhere in their community and can use that sprawling stature to manipulate the drug market.
  • The third solution is to inject competition into the stale hospital-dominated system. Recent rulings have usurped non-compete clauses, allowing doctors to compete for wages in a regional market.

Click here to read the full op-ed by Dr. Menger.

Editor’s Note: Organized neurosurgery aims to improve competition in the health care system by increasing scrutiny of hospital and other health care consolidation, removing restrictions on physician ownership of hospitals and other ancillary services, establishing network adequacy standards and broadening health insurance coverage options.

In the recently released 2023 Legislative & Regulatory Agenda, the American Association of Neurological Surgeons and the Congress of Neurological Surgeons outline health policy action items the neurosurgical societies plan to advance with Congress and the Biden Administration.

We hope you will share what you learn from our posts. We invite you to join the conversation on Twitter by following @Neurosurgery.

April 3, 2023
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