Skip to main content
search

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
Love0

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
Love0

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
Love0

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
Love0

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
Love0

Cross-Post: We need more than brain injury awareness: We need new treatment

By 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 that we believe will interest our readers. Today’s op-ed originally appeared on Roll Call. Rep. Bill Pascrell Jr. (D-N.J.), co-chair and founder of the Congressional Traumatic Brain Injury Task Force, and Vishal Bansal, MD, FACS, discuss the need for more than brain injury awareness — the need for new treatment.

Each March, Brain Injury Awareness Month promotes learning more about brain injury and ending its dangerous effects. The American Association of Neurological Surgeons puts annual direct and indirect costs of the full spectrum of traumatic brain injuries (TBI) — from mild to severe — at $48 billion to $56 billion in 2019 and $76.5 billion today. More than 3 million patients visit hospital emergency rooms with suspected TBI annually.

Rep. Pascrell and Dr. Bansal state, “We have achieved widespread acknowledgment in recent years that TBI is a public health issue that contributes to disability and death. Yet, little has changed in the standard of care for concussions as the medical community is still striving for therapy that would treat both the symptoms and the underlying concussion. We can do more and should do better.”

Despite progress, concussions are still a significant unmet medical need. The authors conclude the op-ed by stating that more resources are needed today to support cutting-edge research and development for effective treatments for concussion.

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 hashtags #neurosurgery and #BrainInjuryAwareness.

March 24, 2023
Love0

How a Small Education Campaign Helped Change the Landscape of Concussion Education and Policy

By Guest Post, TBI, Trauma, Traumatic Brain InjuryNo Comments

Figure 1: CDC HEADS UP materials 2003 through present

This March, in recognition of Brain Injury Awareness Month, we want to take a moment to reflect on the momentous progress that has been made related to concussion education over the last 20 years. During that time, the Centers for Disease Control and Prevention’s (CDC) HEADS UP concussion education initiative started as a small campaign and grew to become an integral part of concussion education. This had a substantial impact on concussion laws and policies nationwide.

In the Children’s Health Act of 2000 (H.R. 4365) (Library of Congress, 1999–2000), Congress charged CDC to develop a public information campaign to broaden public awareness of the health consequences of traumatic brain injury. In response, in 2003, CDC released the HEADS UP: Brain Injury in Your Practice tool kit for health care providers. The goal of the tool kit was to improve awareness among primary care providers about the diagnosis and management of mild traumatic brain injury, an under-diagnosed and under-identified injury. Since then, CDC HEADS UP has become the go-to resource for concussion prevention and education — reaching millions of Americans with concussion information. CDC HEADS UP materials cover how to prevent, recognize and respond to a possible concussion or other serious brain injury. It has grown to include materials for health care providers, coaches, parents, school professionals, sports officials, and kids and teens (Figure 1). Some successes of CDC HEADS UP include:

  • Reaching more than 200 million people through ad campaigns, PSAs and more;
  • Partnering with more than 85 organizations (including the American Association of Neurological Surgeons and the Congress of Neurological Surgeons) across the fields of athletics, health care, public health, education and scientific research; and
  • Creating over 100 communication products to promote concussion prevention and care.

Educating People and Communities

One of the biggest achievements of CDC HEADS UP has been its ability to support the implementation of Concussion in Sports laws that now exist in all 50 states and the District of Columbia. Concussion in sports laws (sometimes referred to as return-to-play laws) was first passed in Washington state in 2009. These laws focus on concussion safety for youth. Most require that coaches and others involved in youth sports receive training on concussion identification and response before the start of the sports season. CDC HEADS UP provides six online training courses designed for coaches, health care providers, school professionals, athletic trainers and sports officials (Figure 2). The availability of these quality training courses (at no cost) allows states, sports programs and schools to comply with education requirements contained in concussion in sports laws and policies. To date, more than 10 million people nationwide have completed at least one of these six training courses.

Figure 2: CDC HEADS UP online training courses on concussion used nationwide to implement state concussion policies and laws

Importantly, CDC HEADS UP educational initiatives and materials align with the best scientific

evidence available on concussion prevention and management. Studies show that CDC HEADS UP materials:

  • Increase communication about concussion between athletes and their parents;1
  • Reach a large number of coaches and parents and improve their knowledge about concussions;2-4
  • Lead coaches and others to view concussion more seriously;3,5,6
  • Increase the capacity of youth sports coaches to prevent, recognize and respond to sports-related concussions appropriately;6
  • Improve knowledge about symptom resolution and return-to-play recommendations;3,6 and
  • Improve awareness of underreporting of concussions among athletes.3

CDC HEADS UP to the Future!

CDC HEADS UP has contributed to a new landscape of concussion awareness in the United States — building, improving and supporting concussion safety around the country. However, the work of the campaign is not yet done. Exciting upcoming CDC HEADS UP initiatives include:

  • An updated and expanded training for youth sports coaches—the most popular CDC HEADS UP product;
  • Resources to help parents of toddlers and young children learn about concussion safety, prevention and care; and
  • Enhanced efforts to reduce disparities through concussion educational materials tailored for American Indian/Alaska Native, Black and Hispanic parents and youth.
  • Make a Difference Where You Live

CDC works to put HEADS UP concussion materials into the hands of parents, healthcare and school professionals, coaches, athletes and others. You can support this mission by:

In 2023, we celebrate 20 years of CDC HEADS UP’s contribution to the substantial strides in educating the public about concussion. Together we all can play a part in ensuring that the next generation of children is better protected from concussions and their potentially serious effects.

References:

  1. Zhou, H., Ledsky, R., Sarmiento, K., DePadilla, L., Kresnow, M.J., Kroshus, E. (2022).Parent–Child communication about concussion: What role can the Centers for Disease Control and Prevention’s HEADS UP concussion in youth sports handouts play? Brain Injury, 36:9, 1133-1139, https://doi.org/10.1080/02699052.2022.2109740.
  2. Parker, E. M., Gilchrist, J., Schuster, D., Lee, R., & Sarmiento, K. (2015). Reach and Knowledge Change Among Coaches and Other Participants of the Online Course: “Concussion in Sports: What You Need To Know.” Journal of Head Trauma Rehabilitation, 30(3), 198–206. https://doi.org/10.1097/HTR.0000000000000097.
  3. Daugherty, J., DePadilla, L., & Sarmiento, K. (2019). Effectiveness of the US Centers For Disease Control and Prevention Heads Up Coaches’ Online Training as an Educational Intervention. Health Education Journal, 78(7), 784–797. https://doi.org/10.1177/0017896919846185.
  4. Rice, T., & Curtis, R. (2019). Parental Knowledge of Concussion: Evaluation of the CDC’s “HEADS UP to Parents” Educational Initiative. Journal of Safety Research, 69, 85–93. https://doi.org/10.1016/j.jsr.2019.02.007.
  5. Daugherty, J., DePadilla, L., Sarmiento, K. (2020). Assessment of HEADS UP online training as an educational intervention for sports officials/athletic trainers. Journal of Safety Research, 74:133-141. https://doi.org/10.1016/j.jsr.2020.04.015.
  6. Covassin, T., Elbin, R. J., & Sarmiento, K. (2012). Educating Coaches About Concussion in Sports: Evaluation of the CDC’s “HEADS UP: Concussion In Youth Sports” Initiative. The Journal of School Health, 82(5), 233–238. https://doi.org/10.1111/j.1746-1561.2012.00692.x.
March 22, 2023
Love0