Neurosurgical Practice in Transition: A Review.

Abstract:

:Neurosurgery is experiencing a period of acute change driven by 2 forces: (1) the perception that the healthcare system in the United States is wasteful and that patients are receiving low "value" care, (2) the belief that quality and long-term outcomes can be measured accurately. We believe 3 important shifts will emerge as a result of these forces. First, payment models will change. They will become anchored to a concept of population health, with capitation payments on a per-patient basis going to provider entities that undertake financial risk. Second, fee-for-service payments will be tied increasingly to administrative and clinical quality measures. Finally, out-of-pocket costs for patients will increase and affect both treatment decisions and willingness to participate in restrictive health care networks. In this review, we describe these changes and discuss possible consequences. We note the changing demographics of neurosurgical practices. Overall, independent private practices, managed by the neurosurgeons, will decline. The proportion of fee-for-service cases will decrease while cases reimbursed through capitation will increase. Physician integration with provider organizations, whether via full employment, a "lease," or some other arrangement, will also increase. We note the increasing importance of quality measures, and how they are likely to affect neurosurgical practices and reimbursement. We describe the advantages and disadvantages of fee-for-service and population health; describe opportunities and risks arising from these transitions; and outline strategies to thrive in a changing environment.

journal_name

Neurosurgery

journal_title

Neurosurgery

authors

Kim DH,Dagi TF,Bean JR

doi

10.1093/neuros/nyx008

subject

Has Abstract

pub_date

2017-04-01 00:00:00

pages

S4-S9

issue

4S

eissn

0148-396X

issn

1524-4040

pii

3077272

journal_volume

80

pub_type

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