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Cross-Post: Medicare for All, Surgery for Some

By Cross Post, Prior AuthorizationNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they hit the mark on an issue. Today’s post originally appeared in The American Spectator on April 29, 2021. In the op-ed, Richard Menger, MD, MPA, assistant professor of neurosurgery and political science at the University of South Alabama in Mobile, Ala. discusses the recent Centers for Medicare & Medicaid Services (CMS) announcement to begin prior authorization for specific procedures, including spine surgery, starting July 1. Insurance companies currently use prior authorization to limit the services they provide for their customers.

According to Dr. Menger, “The prior-authorization process does not serve as a national guidelines-based quality control process to ensure local physicians adhere to stringent medical standards. Rather, it serves as opaque obfuscation and deterrence.” Prior authorization is generally not driven by scientific data. It delays care and serves as an obstacle to medically necessary patient care, disrupting the patient-physician relationship.

Click here to read the full article in The American Spectator and here for the CMS prior authorization policy.

Editor’s Note: We hope that 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, 2021
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Cross-Post: Overlapping Surgery: A Safe and Smart Way to Fix COVID-Related Backlogs

By COVID-19, Cross PostNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they hit the mark on an issue. Today’s post originally appeared in The American Spectator on April 1, 2021. In the op-ed, Richard Menger, MD, MPA, assistant professor of neurosurgery and political science at the University of South Alabama in Mobile, Ala. and Anthony M. DiGiorgio, DO, MHA, assistant professor of neurosurgery at the University of California San Francisco in San Francisco, Calif. highlight the opportunity for overlapping surgery to assist with the backlog of neurosurgical cases due to COVID-19.

Across the country, many non-urgent surgeries were canceled or delayed due to COVID-19. Overlapping surgery is the practice of a surgeon being responsible for more than one operating room at a time with non-critical portions of the procedure overlapping. When properly and ethically integrated, Drs. Menger and DiGiorgio use overlapping surgery in neurosurgery to better use health care resources and improve access to care.

In 2016, the American Association of Neurological Surgeons, American Board of Neurological Surgery, Congress of Neurological Surgeons and Society of Neurological Surgeons issued guidelines for the use of overlapping surgery.

Click here to read the full article in The American Spectator.

Editor’s Note: We encourage everyone to join the conversation online by using the hashtags #Neurosurgery and #COVID19.

April 9, 2021
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Highlighting the Global Influence of Women in Neurosurgery

By AANS Spotlight, Cross Post, Women in NeurosurgeryNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other sources that we believe are relevant to our audience. Since this week featured International Women’s Day, we wanted to bring your attention to the March 2021 Neurosurgical Focus issue on International Women Leaders in Neurosurgery: Past and Present exploring women’s roles in neurosurgery over the years.

Topics include the impact of culture and history on women’s progress and the global influence of women in neurosurgery. Historical reports highlight noteworthy examples of women neurosurgeons around the globe who have demonstrated vision and leadership. The series discusses the presence of women neurosurgeons at the podium at scientific and medical society gatherings and the emerging roles of women as leaders in international organizations. Various aspects of research are described, including funding gaps and publication rates.

The series proposes strategies to expand opportunities for success for women neurosurgeons. A future that actively encourages the best and brightest medical students to choose neurosurgical careers — regardless of gender, ethnicity, religion, culture, sexual orientation or identity, socioeconomic strata or any other individual defining characteristic — will best serve the needs of the profession and patients.

Read the following articles in the series:

 

Editor’s note: We hope that you will share what you learn from our posts. We invite you to be part of the conversation on Twitter by following @Neurosurgery and using the hashtag #WomenInNeurosurgery

March 10, 2021
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Practice Restructuring in the COVID-19 Era

By CNS Spotlight, COVID-19, Cross PostNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other sources that we believe are relevant to our audience. We wanted to bring attention to this article from the Winter 2021 issue of Congress Quarterly titled “Considerations for Private Practice Groups in the Age of COVID.” Stacey Lang, an executive administrator at the University of Pittsburgh Medical Center and a volunteer with the Neurosurgery Executives’ Resource Value & Education Society, outlines both short-term and long-term considerations for practice restructuring in the COVID-19 era, including staffing, facility and scheduling matters.

According to a recently released American Medical Association survey, the average number of weekly office visits per provider fell by over 50%. In addition, while on average physicians experienced a 32% drop in revenue since February, approximately 20% saw reductions of 50% or more. Less than 20% of physicians reported no decrease in revenue. Given the duration of the pandemic thus far, it is difficult to remember what everyday practice was and to imagine that we will, at some point, return to normal, albeit a new normal.

To read the complete article, click here.

Editor’s Note: We encourage everyone to join the conversation online by using the hashtags #COVID19 and #Neurosurgery.

February 16, 2021
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RVU Compensation Model Insufficient for Measuring the Value of Academic Surgeons

By CNS Spotlight, Cross PostNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other sources that we believe are relevant to our audience. We wanted to bring attention to the recent analysis of the worth of neurosurgeons in academic departments by Elad I. Levy, MD, FAANS, MBA, FACS, FAHA; Kunal Vakharia, MD; and Michael Cournyea, CEO of the University at Buffalo Neurosurgery, Inc. This article from the Winter 2021 issue of Congress Quarterly examines how the relative value unit (RVU) system is insufficient for effectively measuring an academic surgeon’s impact and value and proposes alternative strategies for developing appropriate compensation models for teaching faculty.

Academic neurosurgical departments are the lifeblood of the neurosurgical profession — their mission is to train the next generation of neurosurgeons. By educating stakeholders such as health care systems, universities, philanthropic entities and the community of the importance of each of the subspecialties in neurosurgery, it becomes possible to create appropriate compensation models for teaching faculty.

To read the complete article, click here.

Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #Neurosurgery.

February 9, 2021
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Novel Strategies for Reducing Health Care Costs

By CNS Spotlight, Cross Post, Healthcare CostsNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other sources that we believe are relevant to our audience. We wanted to bring attention to the article from the Winter 2021 issue of Congress Quarterly, titled “Cost Effectiveness in Cranioplasty: Investigational 3D-Printed Method for Patient-Specific Cranial Implant.” Daniel Solomon; Jonathan A. Forbes, MD, FAANS; Joseph S. Cheng, MD, MS, FAANS; and Alice Xu from the University of Cincinnati, College of Medicine examine methods to reduce the cost of patient-specific cranial implant (PSCI) by approximately 70% via 3D printing and investigational technology.

Figure 1: (A) and (B) cadaveric specimen following right decompressive craniectomy. (C) Same specimen pictured following cranioplasty with patient-specific cranial implant. PSCI printed/constructed using investigational freeware.

Finding novel ways to reduce surgical expenditures reduces the financial burden on hospitals and patients without compromising quality of care. Strategies such as this are increasingly important as the U.S. continues to push towards value-centric health care.

To read the complete article, click here.

Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #Neurosurgery.

February 3, 2021
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Cross-Post: Streamlining the Process of Prior Authorization for Medical and Surgical Procedures

By Cross Post, Health Reform, Prior Authorization, Regulatory ReliefNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they hit the mark on an issue. Today’s post originally appeared in The Hill on Jan. 14, 2021. In the op-ed, Richard Menger, MD, MPA, assistant professor of neurosurgery and political science at the University of South Alabama in Mobile, Ala., highlights the need to streamline the cumbersome process of prior authorization for medical and surgical procedures performed through the Medicare Advantage program. Prior authorization is a tool insurance companies use to limit the services they provide for their customers. “Reducing the footprint of prior authorization bends the arc towards that proper direction of reform,” according to Dr. Menger.

Click here to read Dr. Menger’s full article in The Hill.

Editor’s Note: We encourage everyone to join the conversation online by using the hashtags #FixPriorAuth and #RegRelief.

January 20, 2021
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Cross-Post — Neurosurgery Publishes Decompressive Craniectomy Update to the Guidelines for the Management of Severe Traumatic Brain Injury

By CNS Spotlight, Cross Post, TBI, Traumatic Brain InjuryNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they hit the mark on an issue. Clinical guidelines have widespread impact and practical utility for practitioners. We want to bring attention to these updates, which recently appeared in Neurosurgery, the official journal of the Congress of Neurological Surgeons, which publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology and medicine.

In September of 2020, Neurosurgery published “Guidelines for the Management of Severe Traumatic Brain Injury: 2020 Update of the Decompressive Craniectomy Recommendations,” adding to the 2017 publication, “Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition,” in the spirit of living guidelines.

According to the Brain Trauma Foundation press release, this update “delineates key knowledge gaps which remain insufficiently informed by evidence.” Incorporating new evidence from the RESCUEicp study and 12-month outcome data from the DECRA study, these guidelines provide three new level-IIA recommendations and validates a previously presented level-IIA recommendation.

To read the full Neurosurgery article, click here.

Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #TBI.

October 7, 2020
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CNS Publishes New Concussion Guidelines

By CNS Spotlight, Concussion, Cross Post, GuidelinesNo Comments

Published online in Neurosurgery, the official journal of the Congress of Neurological Surgeons (CNS), in August, the “Concussion Guidelines Step 2: Evidence for Subtype Classification,” provides support for re-thinking the way we diagnose concussion.

Angela K. Lumba-Brown, MD, co-director of the Stanford Brain Performance Center, Assistant Professor of Emergency Medicine at Stanford University, and co-author of the guideline, states that because concussion symptoms may vary greatly from person to person, early subtyping can direct strategies for recovery.

The study represents the work of a multidisciplinary team of experts across the country, unified to define five common concussion subtypes:

1. Headache/Migraine
2. Vestibular
3. Cognitive
4. Oculomotor
5. Anxiety/Mood

Notably, two concussion-associated conditions — sleep disturbance and cervical strain — often occur in relation to subtypes, but do not stand alone as concussion diagnostic criteria.

Through a rigorous review of the scientific literature and meta-analysis, the expert workgroup identified differences in the prevalence of each subtype shortly following head injury. Studying the first few days following a concussion is critical because the majority of scientific literature to-date examines concussion signs and symptoms spanning the first week to a month following injury, during which large variability in recovery patterns occur.

  • This study provides support for the presence of all five subtypes as early as three days following injury — directing an urgent change in the way concussion is currently diagnosed. For example:
    Anxiety and mood symptoms, often thought to manifest much later in the concussion course, are present in a large portion of patients early on.
  • Both children and adults exhibit vestibular impairments immediately following a concussion, representing an opportunity for early intervention with vestibular therapies.

This work demonstrates that a comprehensive, initial concussion assessment should incorporate evaluations of all five subtypes and two associated conditions. This work was supported by the Brain Trauma Evidence-Based Consortium, a U.S. Department of Defense-funded project in collaboration with the Brain Performance Center at Stanford University and the Brain Trauma Foundation.

To read the full Neurosurgery article, click here.

Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #CNSGuidelines.

January 2, 2020
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Congress of Neurological Surgeons Releases New Pediatric Guidelines

By CNS Spotlight, Cross Post, Pediatrics, Quality ImprovementNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting or linking to items from other places when we believe they hit the mark on an issue. We wanted to bring attention to a Congress of Neurological Surgeons (CNS) evidence-based guideline on pediatric myelomeningocele that recently appeared in Neurosurgery, the official journal of the CNS, which publishes research on clinical and experimental neurosurgery covering the very latest developments in science, technology and medicine.

In August, Neurosurgery published the “Congress of Neurological Surgeons (CNS) Systematic Review and Evidence Based Guidelines for Pediatric Myelomeningocele,” which includes 6 chapters that systematically review the literature and include evidence-based recommendations about the timing of closure after birth, hydrocephalus, the impact of prenatal closure, and the effect of prenatal closure on ambulation ability and tethered spinal cord.

According to the CNS press release, “it is the Guideline Task Force’s aim that these systematic reviews and subsequent evidence-based recommendations will lead to improvement in the quality of life for infants and children with myelomeningocele.”

To read the full Neurosurgery article, click here. The complete guideline can also be found on the CNS website, here.

Editor’s Note: We encourage everyone to join the conversation online by using the hashtag #CNSGuidelines.

Catherine A. Mazzola, MD

David F. Bauer, MD

 

November 12, 2019
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