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Neurosurgery Blog Featured on Medscape’s List of Medical Blogs Physicians Love

By Health ReformNo Comments

On Feb. 16, Medscape published an article, “‘Blog MD’: Medical Blogs That Physicians Love,” including Neurosurgery Blog on their list of 10 medical blogs for physicians. The article states, “the blog authored by the AANS and CNS tackles topics beyond brain surgery. Physicians and other specialists could learn from writings about a neurosurgeon’s approach to mentorship, artificial intelligence in the treatment of stroke patients, and creating a pathway for the next generation of neurosurgeons.”

In the last 12 years, the Neurosurgery Blog has published nearly 550 blog posts. The article notes that the blog’s mission is to investigate and report on how health care policy affects patients, physicians and medical practice and to illustrate that the art and science of neurosurgery encompass much more than brain surgery. Its health policy reporting efforts include multiple topic months and guest blog posts from key thought leaders and members of the neurosurgical community.

Click here to read the article.

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

April 1, 2024
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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: 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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Cross-Post: Death by 10,000 Clicks: The Electronic Health Record

By Health ReformNo 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 be of interest to our readers. Today’s post originally appeared in MedPage Today on Jan. 21. In the op-ed, neurosurgeons Anthony M. DiGiorgio, DO, MHA, and Praveen V. Mummaneni, MD, MBA discuss the burden of electronic health records (EHR) at their institution, the University of California San Francisco.

Drs. DiGiorgio and Mummaneni audited EHR logs to examine our neurosurgery residents’ work and better understand the benefits and burdens. The results found that on-call residents spent 20 hours logged into the EHR over a single shift. They are detracting from trainees’ educational experience, and health care costs are increasing because of the inefficiencies that come with EHRs.

Drs. DiGiorgio and Mummaneni note that many inefficiencies come from Medicare regulations. For example, the appropriate use criteria program was developed to reduce unnecessary imaging ordered by physicians. Their EHR audit found this added just a few minutes of computer time to the residents’ days. However, there is no evidence that this regulation reduces unnecessary imaging. Many more regulations add a few minutes here and a few minutes there.

Drs. DiGiorgio and Mummaneni state that “it’s death by 10,000 clicks” and urge continued involvement in advocacy to reverse the ever-increasing EHR burden.

Click here to read the full article.

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 #EHR.

January 26, 2023
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Neurosurgeons Putting Patients First

By Access to Care, Faces of Neurosurgery, Health Reform, MedicareNo Comments

The Medicare physician payment system is on an unsustainable path that has failed to keep up with inflation over the years, threatening patient access to care. The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) are actively engaged in preventing steep Medicare payment cuts and preserving patient access to care through the Surgical Care Coalition. The coalition is in year three of its campaign to stop these cuts and implement lasting changes to the physician payment and quality improvement systems.

On Jan. 1, 2023, neurosurgeons face a minimum 8.5% Medicare payment cut, including a nearly 4.5% cut for all Medicare Physician Fee Schedule services and a 4% Statutory Pay-As-You-Go Act cut, triggered due to new federal spending. After successfully protecting patients’ timely access to quality surgical care in 2020 and 2021 by securing Congressional action to mitigate proposed cuts to Medicare, the coalition is fighting against similar cuts proposed for 2023. The AANS and the CNS are also working with Congress on long-term solutions to fix these broken systems. To that end, we submitted detailed comments in response to a Congressional request for information.

The people who the proposed cuts will most impact are our patients. Every day, neurosurgeons take care of some of the sickest patients who face painful and life-threatening neurologic conditions. Alexander A. Khalessi, MD, FAANS, John K. Ratliff, MD, FAANS and Maya A. Babu, MD, FAANS, share their experiences as neurosurgeons and how the cuts will impact neurosurgical practices and their patients. The videos are available as follows:

Patient Process

Why I Became a Surgeon

Earning a Patient’s Trust

Medicare Cuts are Back

Patients Deserve Timely, Quality Care

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 @SurgeonsCare.

November 9, 2022
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Cross-Post: Physician Pay Cuts Are Another Threat to Independent Practices

By Cross Post, Health Reform, MedicareNo 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 Nov. 13, 2021. In the op-ed titled “Physician pay cuts are another threat to independent practices,” Richard Menger, MD, MPA, assistant professor of neurosurgery and political science at the University of South Alabama in Mobile, Ala., discusses how the 9% Medicare physician pay cuts for medical services starting Jan. 1, 2022, will have enormous consequences for the entire health care system.

According to Dr. Menger, “Medicare physician pay has increased only 11 percent from 2001-2020. Meanwhile, the cost of running a medical practice increased 39 percent from 2001-2020.  Adjusting for inflation and the cost of running a practice, Medicare physician pay dropped 22 percent over the time period.” He continued, “Medicare payment to hospitals increased nearly 60 percent over the same time period.”

Medicare physician pay cuts place external pressure on physicians and drives them into more hospital-employed practices. Hospitals are merging and consolidating around regional health care markets on an astounding basis. Dr. Menger noted that a collection of the country’s leading surgical societies, the Alliance of Specialty Medicine and the Surgical Care Coalition, recognize this downward pressure as impossible to maintain.

Click here to read the full article in The Hill.

Editor’s Note: We encourage everyone to join the conversation online by following @Neurosurgery, @SpecialtyDocs and @SurgeonsCare and using the hashtag #Neurosurgery.

November 17, 2021
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Permanently Funding CHIP is Essential for the Health of Our Children

By Guest Post, Health Reform, PediatricsNo Comments

The Children’s Health Insurance Program (CHIP) is a health insurance program that provides coverage to children from low-income families. CHIP was established in 1997 with strong bipartisan support and is an essential state-federal partnership. As many as 15% of children lacked health insurance coverage at the time. According to the American Academy of Pediatrics (AAP), Medicaid and CHIP provided health insurance to more than 50% of U.S. children in 2012, making both programs combined the nation’s largest insurer. These children and their families depend on federally subsidized state Medicaid for their health insurance.

As a pediatric neurosurgeon in New Jersey, I have seen how these programs help children and allow them to have their well visits, sick visits and hospitalizations covered. The program is not perfect — for example, provider reimbursements are typically well below market rates and fail to cover physician practice costs. Thankfully, however, many physicians in our state — and across the U.S. — accept CHIP-covered patients providing access to care is needed for these children who otherwise would not receive the medical and surgical care that they so desperately need. And as we know, healthy children grow up to become healthy adults.

Unfortunately, since the program’s inception, Congress must reauthorize CHIP every few years, putting this vital coverage in jeopardy. In fact, at one point in 2018, CHIP funding lapsed for an unprecedented 114 days. While Congress extended CHIP funding through 2027, the program remains vulnerable without permanent financing.

Fortunately, Congress is currently considering legislation to fund CHIP permanently. One such effort is being led by Reps. Vern Buchanan (R-Fla.) and Lucy McBath (D-Ga.). Endorsed by the American Association of Neurological Surgeons and Congress of Neurological Surgeons, the Comprehensive Access to Robust Insurance Now Guaranteed (CARING) for Kids Act (H.R. 66) would ensure that gaps in CHIP coverage would never again happen.

Kids need access to care, and pediatric neurosurgical patients depend on CHIP funding. We need to provide adequate health care for children from low-income households. We have a fiduciary responsibility and an ethical obligation to support permanent funding for the CHIP. This is not just my opinion, but truth and reality. If Congress does not act, federal funding for CHIP will expire.

CHIP has provided access to care that low-income families would not have had otherwise. As a nation, we need to come together to support permanently funding CHIP through the CARING for Kids Act or similar federal legislative efforts so our children will have access to health care that they so desperately need.

Please help make permanent funding a reality by taking a moment to contact Congress and ask your representative to co-sponsor H.R. 66. Click here to go to neurosurgery’s Advocacy Action Center to send an email to your elected officials asking them to co-sponsor H.R. 66. A sample message, which can be personalized, is provided. It takes less than a minute to make a difference in the lives of millions of children and their families, so please act today!

 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 #FundCHIP.

Catherine A. Mazzola, MD, FAANS
New Jersey Pediatric Neuroscience Institute
Morristown, N.J.

October 25, 2021
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Cross-Post: A Way Forward For The Imaging Appropriate Use Criteria Program: Aligning Quality Metrics

By Cross Post, Health Reform, MedicareNo 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 Health Affairs on Aug. 26, 2021. The article, “A Way Forward For The Imaging Appropriate Use Criteria Program: Aligning Quality Metrics,” discusses proposed changes to the Centers for Medicare & Medicaid Services (CMS) calendar year 2022 proposed Medicare Physician Fee Schedule (PFS) Rule and implementation of the Appropriate Use Criteria (AUC) program. Mandated by the Protecting Access to Medicare Act (PAMA), the AUC program requires physicians ordering advanced diagnostic imaging to consult with AUC using an approved clinical decision support mechanism before the radiologist can provide the scan.

As the Health Affairs piece points out, following the release of the  PFS, the House Appropriations Health Subcommittee included in its report a provision for CMS to inform Congress about the implementation of the AUC program, including any challenges and successes. The AANS and the CNS have urged Congress to repeal the AUC program, given the additional burdens on physicians and potential delays in imaging services. At the very least, the neurosurgical societies have recommended that Congress adopt legislation that directs CMS to incorporate AUC for diagnostic imaging into the existing Quality Payment Program.

Click here to read the full article in Health Affairs.

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

September 13, 2021
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Cross-Post: Bipartisan Bill Would Improve Medicare Patients’ Access to Care

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 American Spectator on July 21, 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 how H.R. 3173, the Improving Seniors’ Timely Access to Care Act, could bring transparency to the process of prior authorization in Medicare Advantage (MA) plans.

Prior authorization is a tool insurance companies use to limit the services they provide for their customers. If passed, this legislation would reduce prior authorization hassles and help curb unnecessary delays for patients. “It’s quite rare for a piece of legislation to have the direct ability to truly impact the lives of so many of my patients. It’s even rarer for that legislation to have bipartisan support,” according to Dr. Menger.

To bring needed transparency and oversight to the MA program, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) are urging Congress to adopt H.R. 3173, the Improving Seniors’ Timely Access to Care Act. Please contact Congress and ask your Representative to co-sponsor H.R. 3173.

Click here to go to neurosurgery’s Advocacy Action Center to send an email to your Representative asking them to co-sponsor the Improving Seniors’ Timely Access to Care Act. A sample message, which can be personalized, is provided.

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

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.

July 26, 2021
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