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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: 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
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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
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Cross-Post: A Night in the Life of a Busy Neurosurgical Resident

By Career, Cross PostNo 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 on Medicine @ Brown Magazine. Abdul-Kareem Ahmed, MD, provides a poignant depiction of one night as a neurosurgical resident at the University of Maryland. Every patient’s worst moment is Dr. Ahmed’s every day. Read More

February 24, 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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Cross-Post: Insurance Companies Use Stalling Tactics to Save Themselves Money

By Access to Care, Burnout, Prior AuthorizationNo 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 The American Spectator on Jan. 3. In the op-ed, neurosurgeon Richard Menger, MD, MPA, FAANS and nurses Jessica Murfee, RN, BSN and Erin Roberts, RN, BSN, discuss health care provider burnout from the cumbersome prior authorization process required by insurance companies to perform surgery agreed upon by patient and surgeon.

The time-consuming prior authorization process disregards the patient-physician relationship. It also causes burnout for health care workers, and “Most of the time, it’s an administrative clarification issue, but calling into the insurance abyss is like dialing into a time warp.”

See 2021 AMA prior authorization physician survey

A survey from the American Medical Association noted that, on average, offices spend 13 hours per week on prior authorizations. The article states, “If a higher-level evaluation is needed, either myself or my physician assistant or nurse practitioner will have to get on the line and debate the merits of a neurosurgery with some other type of health representative who is acting on behalf of the insurance company.”

The piece concludes with the authors asking Congress to take action and pass legislation to streamline prior authorization in Medicare Advantage. The Improving Seniors Timely Access to Care Act would require enhanced transparency and streamline authorization in the Medicare Advantage program.

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 #FixPriorAuth.

January 18, 2023
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Brain Tumor Nonprofit StacheStrong Donates $110,000 for the Launch of the SNS Neurosurgeon-Scientist Training Program

By Brain Tumor, Career, TumorNo Comments

The Society of Neurological Surgeons (SNS) has established a Neurosurgeon-Scientist Training Program (NSTP) to increase the pool of neurosurgery residents conducting research and to enhance their success rate in becoming independent neurosurgeon-scientists. The NSTP will serve as a formal mentored research program for those neurosurgery residents who are beginning a protected research year or have already completed their protected research year.

The primary goal of this new program is to improve human health by providing participants with the skills, mentorship, education and experience needed to successfully compete for individual research funding (e.g., National Institutes of Health K awards and R01 research grants). Additional research by clinician-scientist neurosurgeons is critical to the fundamental discovery that advances new methods of care and new cures.

A donation of $110,000 by the non-profit StacheStrong provides crucial funding for brain tumor-related grants with the launch of the NSTP. StacheStrong is devoted to raising funds and awareness for brain cancer research. Defeating brain cancer and improving the quality of patients’ lives is the mission of StacheStrong.

Click here to read the press release.

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, @SNS_Neurosurg and @StacheStrong and using the hashtag #BrainCancerResearch.

January 13, 2023
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