A national survey of neurosurgeons indicates many are limiting their Medicare practice in some way and more will do so if drastic Medicare physician payment cuts continue.
The online survey of 678 neurosurgeons was commissioned by the American Association of Neurological Surgeons, the Congress of Neurological Surgeons and the Council of State Neurosurgical Societies. Perception Solutions conducted the survey in September 2009.
“These results really do paint a bleak path we are going down,” said Troy M. Tippett, MD, president of the AANS. “Many neurosurgeons in our survey indicated that if Medicare payments continue to decline, they would stop providing certain services, reduce staff, defer purchase of new medical equipment, reduce time spent with Medicare patients and begin referring complex cases elsewhere.”
Survey respondents indicated that they are reducing the number of Medicare patients in their practice due to low reimbursement (59.2 percent). Those neurosurgeons who limit the number of Medicare appointment slots do so through the scheduling process (42 percent), by limiting the overall number of Medicare patients they treat (35 percent), or by selecting patients based on their geographic location (10 percent).
Nearly forty percent of respondents indicated that if Medicare payments continue to decline, they will decrease the number of new Medicare patients they see and over eighteen percent would no longer take any new Medicare patients. Over fifty percent of neurosurgeons said they would stop providing certain services and nearly fifty-three percent will reduce the time they spend with Medicare patients.
"When we asked neurosurgeons how they limit the number of new Medicare patients they see, we received responses like, 'I personally screen new Medicare patients' or 'I will see no more than two new Medicare patients a week' or 'I only see referrals,'" said William E. Bingaman, MD, chair of the CSNS. "Medicare payment rates are an important issue that most neurosurgeons have to deal with and strategize for on a daily basis. Our current payment system is clearly not working and the study simply reinforces that notion."
The survey results also revealed that not all U.S. geographic locations are alike, and Medicare patients in the Southwest, in particular, are now facing more difficulties in finding neurosurgeons that currently treat Medicare patients.
Bingaman said access to neurosurgical care for new and established Medicare patients in the Southwest and Southeast would likely be a challenge if Medicare payments continue to decline. When compared to the national average, the Northwest and Northeast quadrants appear to be a bit more stable.
Tippett said the two professional societies were urging Congress to permanently repeal the sustainable growth rate (SGR) formula, to prevent the further erosion of patients' access to care. He said the AANS and CNS do not support temporary "fixes" to the payment problem, as they would only make it more costly to repeal the SGR in the future.