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Cross-Post: Gender Differences in Medicare Practice and Payments to Neurosurgeons

By Cross Post, Medicare, Women in NeurosurgeryNo 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 JAMA Surgery.​ The article — “Gender Differences in Medicare Practice and Payments to Neurosurgeons” by Temitope O. Oshinowo, AB, et al. compares practice metrics and earning potential between female and male neurosurgeons and examines gender disparity in Medicare reimbursement.

The authors state that despite efforts to promote diversity within the neurosurgical workforce, individuals from underrepresented groups face significant challenges. Females account for approximately 50% of medical school graduates but comprise just 18.2% of neurosurgery residents and only 6% of board-certified neurosurgeons. Female physicians in the U.S. are estimated to be compensated 25% less, or the equivalent of $2 million, in career-long earnings.

Using Medicare data across practice settings, the authors examine patterns of significant disparity in procedural volume and payments and found significant gender-based variation in practice patterns and reimbursement among neurosurgeons serving the Medicare fee-for-service population. Female surgeons were reimbursed less than male surgeons for performing the same primary procedure. “While there has been a trend of increased female representation in neurosurgery, women continue to face challenges in establishing, maintaining, and progressing within their neurosurgical careers,” according to Oshinowo et al.

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 @WINSNeurosurge1 and using the hashtag #WomenInNeurosurgery.

December 1, 2023
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Cross-post: Fix the broken Medicare physician payment system that threatens patient access  

By Access to Care, Cross Post, MedicareNo Comments

From time to time on Neurosurgery Blog, you will see us cross-posting to items published elsewhere that we believe will interest our readers. Today’s post originally appeared in The Hill on Oct. 17. In the op-ed, Reps. Larry Bucshon, MD, (R-Ind.), Ami Bera, MD, (D-Calif.), Raul Ruiz, MD, (D-Calif.), and Mariannette Miller-Meeks, MD, (R-Iowa) state that the Medicare payment system fails to reimburse physicians adequately for the critical services they provide. Unlike other providers, the Medicare Physician Fee Schedule (MPFS) does not have an automatic inflationary update and physician payments declined by 26 percent from 2001 to 2023 when adjusted for inflation.

To address this flaw, Reps. Bucshon, Bera, Ruiz and Miller-Meeks introduced the Strengthening Medicare for Patients and Providers Act (H.R. 2474) to modernize the Medicare physician payment system while protecting patients’ timely access to care. This bill would apply a permanent, inflation-based update to the MPFS.

Click here to read the full op-ed and here to contact Congress and urge your representatives to co-sponsor H.R. 2474. Additional information and resources are available at the American Medical Association’s (AMA) Fix Medicare Now website.

The American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS) endorse H.R. 2474. The AANS and the CNS also joined several coalition letters endorsing the bill, including the AMA, Alliance of Specialty Medicine and a coalition of more than one million physician and allied health professional groups.

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

October 25, 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: Why Is It Hard for Grandma To See Her Doctor?

By Cross Post, MedicareNo 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 Nov. 1, titled “Why is it hard for grandma to see her doctor?” 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 steep Medicare physician payment cuts scheduled to go into effect on Jan. 1, 2023, are not a good prescription for a healthy physician workforce.

The average physician will receive 8.5% less for providing the same services they did last year. While adjusting for inflation, Medicare payments to physicians have declined 22% from 2001-2021. According to Dr. Menger, “The people most impacted by these cuts will be our Medicare patients. In the backdrop of inflation, practices will not be able to sustain themselves by treating Medicare patients.” Dr. Menger concludes by stating that this puts seniors at risk for reduced access to care.

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.

November 3, 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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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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Neurosurgeons Launch Campaign to Protect Patient Access to Care

By Access to Care, COVID-19, Guest Post, Health Reform, MedicareNo Comments

Our health care system is under extraordinary pressure. The COVID-19 pandemic has created an uncertain financial future for health care professionals. And now, coming on the heels of this devastating pandemic, Medicare is poised to implement drastic cuts. These cuts threaten patients’ access to timely surgical care and may impact the quality of life for the people neurosurgeons care for every day. To help policymakers and the public understand how these payment cuts will hurt patients and their neurosurgical care teams, on June 18, the American Association of Neurological Surgeons (AANS) and the Congress of Neurological Surgeons (CNS), along with 10 other national surgical associations, officially launched the Surgical Care Coalition (SCC).

The coalition, which represents more than 150,000 surgeons, was formed to stop these Medicare cuts to protect patients, improve their quality of life and ensure that our nation’s seniors have access to the neurosurgeon of their choice when they need life-saving neurosurgical care. Specifically, the SCC is worried about new Medicare payment policies for office and outpatient visits that the Centers for Medicare & Medicaid Services (CMS) will implement in January 2021. Changes to these visit codes — also known as evaluation and management (E/M) codes — will reduce payments for surgical care, which may lead to reduced access to care for older Americans. Working together, the coalition is putting this issue on the nation’s agenda and is urging Congress to pass legislation that will prevent these payment cuts.

To learn just how fragile our health care system is, the SCC recently commissioned a survey of more than 5,000 surgeons. According to this study, surgical practices are facing severe financial distress due to the COVID-19 pandemic. While the cuts were announced before the pandemic, with the combined impact of the planned CMS cuts and the economic challenges due to COVID-19, surgeons and hospitals will face difficult decisions to keep surgical practices afloat. For neurosurgeons, the survey found that even before the CMS cuts take effect:

  • More than one-half (54%) of respondents are concerned that they could be forced to shut down their practice, limiting choice and access to neurosurgical care;
  • Three-quarters (74%) of neurosurgeons are concerned about the finances of their practice, and to keep the doors open, 38% have cut their own salary, and one-quarter (24%) have taken on debt as a result of COVID-19; and
  • In the face of declining revenues, 86% of respondents are worried that they will have to cut employee’s salaries and 76% fear that they may have to permanently layoff employees.

In announcing the SCC initiative, John A. Wilson, MD, FAANS, president of the AANS, noted that “Neurosurgeons take care of critically ill patients who suffer from painful and life-threatening neurologic conditions such as traumatic brain injury, brain tumors, debilitating degenerative spine disorders and stroke, and without timely neurosurgical care, our patients can face permanent neurologic damage or death. He added, “The planned cuts to Medicare payments will further stress a healthcare system critically affected by the pandemic crisis and may negatively impact Medicare beneficiaries’ access to care.”

Echoing his remarks, Steven N. Kalkanis, MD, FAANS, president of the CNS, stated, “It is essential that policymakers understand how these payment cuts may impact access to surgical care. COVID-19 has placed an unprecedented strain on our health care system, and additional Medicare payment cuts will not only threaten timely access to quality care but will also stress an already fragile health care system.”

Our seniors need to take comfort in the fact that a neurosurgeon will be there if and when they ever require neurosurgical care. Medicare cuts hurt patients, and the Surgical Care Coalition is fighting to prevent payment cuts that threaten patients’ timely access to neurosurgical care.

Editor’s Note: Neurosurgery Blog encourages you to follow the coalition on Twitter and LinkedIn, and we invite you to join the conversation at #CutsHurtPatients.

Katie O. Orrico, Esq., director
AANS/CNS Washington Office

June 24, 2020
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