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Quereshy HA, Quinton BA, Ruthberg JS, Maronian NC, Otteson TD. Practice Consolidation in Otolaryngology: The Decline of the Single-Provider Practice. OTO Open 2022; 6:2473974X221075232. [PMID: 35237738 PMCID: PMC8883306 DOI: 10.1177/2473974x221075232] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 01/01/2022] [Indexed: 11/16/2022] Open
Abstract
Objective To observe trends in practice consolidation within otolaryngology by analyzing changes in size and geographic distribution of practices within the United States from 2014 to 2021. Study Design Retrospective analysis based on the Physician Compare National Database from the US Centers for Medicare and Medicaid Services. Setting United States. Methods Annual files from the Physician Compare National Database between 2014 and 2021 were filtered for all providers that listed “otolaryngology” as their primary specialty. Organization affiliations were sorted by size of practice and categorized into quantiles (1 or 2 providers, 3-9, 10-24, 25-49, and ≥50). Both the number of practices and the number of surgeons within a practice were collected annually for each quantile. Providers were also stratified geographically within the 9 US Census Bureau divisions. Chi-square analysis was conducted to test significance for the change in surgeon and practice distributions between 2014 and 2021. Results Over the study period, the number of active otolaryngology providers increased from 7763 to 9150, while the number of practices fell from 3584 to 3152 in that time span. Practices with just 1 or 2 otolaryngology providers accounted for 80.2% of all practices in 2014 and fell to 73.1% in 2021. Similar trends were observed at the individual provider level. Regional analysis revealed that New England had the largest percentage decrease in otolaryngologists employed by practices of 1 or 2 active providers at 45.7% and the Mountain region had the lowest percentage decrease at 17.4%. Conclusion The otolaryngology practice marketplace has demonstrated a global trend toward practice consolidation.
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Affiliation(s)
- Humzah A. Quereshy
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Brooke A. Quinton
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Jeremy S. Ruthberg
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
| | - Nicole C. Maronian
- Department of Otolaryngology–Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
| | - Todd D. Otteson
- School of Medicine, Case Western Reserve University, Cleveland, Ohio, USA
- Department of Otolaryngology–Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, Ohio, USA
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Wilde H, Azab MA, Abunimer AM, Abou-Al-Shaar H, Karsy M, Guan J, Menacho ST, Jensen RL. Evaluation of cost and survival in intracranial gliomas using the Value Driven Outcomes database: a retrospective cohort analysis. J Neurosurg 2020; 132:1006-1016. [PMID: 30925470 DOI: 10.3171/2018.12.jns183109] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2018] [Accepted: 12/13/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Gliomas occur in 3-4 individuals per 100,000 individuals and are one of the most common primary brain tumors. Treatment options are limited for gliomas despite the progressive nature of the disease. The authors used the Value Driven Outcomes (VDO) database to identify cost drivers and subgroups that are involved in the surgical treatment of gliomas. METHODS A retrospective cohort of patients with gliomas treated at the authors' institution from August 2011 to February 2018 was evaluated using medical records and the VDO database. RESULTS A total of 263 patients with intracranial gliomas met the authors' inclusion criteria and were included in the analysis (WHO grade I: 2.0%; grade II: 18.5%; grade III: 18.1%; and grade IV: 61.4%). Facility costs were the major (64.4%) cost driver followed by supplies (16.2%), pharmacy (10.1%), imaging (4.5%), and laboratory (4.7%). Univariate analysis of cost contributors demonstrated that American Society of Anesthesiologists physical status (p = 0.002), tumor recurrence (p = 0.06), Karnofsky Performance Scale score (p = 0.002), length of stay (LOS) (p = 0.0001), and maximal tumor size (p = 0.03) contributed significantly to the total costs. However, on multivariate analysis, only LOS (p = 0.0001) contributed significantly to total costs. More extensive tumor resection in WHO grade III and IV tumors was associated with significant improvement in survival (p = 0.004 and p = 0.02, respectively). CONCLUSIONS Understanding care costs is challenging because of the highly complex, fragmented, and variable nature of healthcare delivery. Adopting effective strategies that would reduce facility costs and limit LOS is likely the most important aspect in reducing intracranial glioma treatment costs.
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Affiliation(s)
- Herschel Wilde
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Mohammed A Azab
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Abdullah M Abunimer
- 2Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; and
| | - Hussam Abou-Al-Shaar
- 3Department of Neurosurgery, Hofstra Northwell School of Medicine, Manhasset, New York
| | - Michael Karsy
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Jian Guan
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Sarah T Menacho
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
| | - Randy L Jensen
- 1Department of Neurosurgery, Clinical Neurosciences Center, University of Utah, Salt Lake City, Utah
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Awan O, Scott KW, Vaziri S, Porche K, Decker M, Dru AB, Chakraborty S, Khare K, Hoh B, Rahman M. Reimbursement patterns for neurosurgery: Analysis of the NERVES survey results from 2011-2016. Clin Neurol Neurosurg 2019; 184:105406. [PMID: 31302381 DOI: 10.1016/j.clineuro.2019.105406] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Revised: 06/25/2019] [Accepted: 06/30/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVE In response to rising national health expenditures, the Patient Protection and Affordable Care Act (ACA) was passed in 2010, with major provisions implemented in 2014. Due to increasing concerns about workload and compensation among neurosurgeons, we evaluated trends in neurosurgical reimbursement, productivity and compensation before and after the implementation of the major provisions of the ACA. PATIENTS AND METHODS Results from Neurosurgery Executives' Resource Value and Education Society (NERVES) annual surveys were collected, representing data from 2011 to 2016. Responses from different practice settings across the six years were categorized into groups, and inverse variance-weighted averaging was performed within the frameworks of a one-way ANOVA model with year. Data from 2011 to 2013 and 2014-2016 were analyzed similarly for differences among practice setting and region. RESULTS The NERVES survey response rates ranged from 20% to 36%. Median values for compensation decreased by 3.66%, 6.42%, and 10.34% within private, hospital, and academic practices respectively after 2014 although these trends did not reach statistical significance. Median work RVUs had a trend to decrease by 5.67%, 13.08%, and 19.44% within private, hospital, and academic practices respectively after 2014. Academic practices showed statistically significant decreases in annual total RVUs, total gross charges and collections. CONCLUSION These data demonstrate neurosurgical reimbursement and productivity have trended down during a time that increases in productivity and reimbursement were predicted. This phenomenon is most notable in academic practices compared to private or hospital based practices. Prospective analyses of the impact of healthcare policy reform on neurosurgical productivity are urgently needed.
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Affiliation(s)
- Omar Awan
- University of Florida College of Medicine, United States
| | - Kyle W Scott
- University of Florida College of Medicine, United States
| | - Sasha Vaziri
- University of Florida College of Medicine, United States; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, United States.
| | - Ken Porche
- University of Florida College of Medicine, United States; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Matthew Decker
- University of Florida College of Medicine, United States; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Alexander B Dru
- University of Florida College of Medicine, United States; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Saptarshi Chakraborty
- College of Liberal Arts and Sciences: Department of Statistics, University of Florida, Gainesville, FL, United States
| | - Kshitij Khare
- College of Liberal Arts and Sciences: Department of Statistics, University of Florida, Gainesville, FL, United States
| | - Brian Hoh
- University of Florida College of Medicine, United States; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, United States
| | - Maryam Rahman
- University of Florida College of Medicine, United States; Lillian S. Wells Department of Neurosurgery, University of Florida, Gainesville, FL, United States
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Nicolosi F, Rossini Z, Zaed I, Kolias AG, Fornari M, Servadei F. Neurosurgical digital teaching in low-middle income countries: beyond the frontiers of traditional education. Neurosurg Focus 2018; 45:E17. [DOI: 10.3171/2018.7.focus18288] [Citation(s) in RCA: 43] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVENeurosurgical training is usually based on traditional sources of education, such as papers, books, direct surgical experience, and cadaveric hands-on courses. In low-middle income countries, standard education programs are often unavailable, mainly owing to the lack of human and economic resources. Introducing digital platforms in these settings could be an alternative solution for bridging the gap between Western and poor countries in neurosurgical knowledge.METHODSThe authors identified from the Internet the main digital platforms that could easily be adopted in low-middle income countries. They selected free/low-cost mobile content with high educational impact.RESULTSThe platforms that were identified as fulfilling the characteristics described above are WFNS Young Neurosurgeons Forum Stream, Brainbook, NeuroMind, UpSurgeOn, The Neurosurgical Atlas, Touch surgery, The 100 UCLA Subjects in Neurosurgery, Neurosurgery Survival Guide, EANS (European Association of Neurosurgical Societies) Academy, Neurosurgical.TV, 3D Neuroanatomy, The Rhoton Collection, and Hinari. These platforms consist of webinars, 3D interactive neuroanatomy and neurosurgery content, videos, and e-learning programs supported by neurosurgical associations or journals.CONCLUSIONSDigital education is an emerging tool for contributing to the spread of information in the neurosurgical community. The continuous improvement in the quality of content will rapidly increase the scientific validity of digital programs. In conclusion, the fast and easy access to digital resources could contribute to promote neurosurgical education in countries with limited facilities.
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Affiliation(s)
- Federico Nicolosi
- 1Department of Neurosurgery, Humanitas Clinical and Research Center, Rozzano (MI)
| | - Zefferino Rossini
- 1Department of Neurosurgery, Humanitas Clinical and Research Center, Rozzano (MI)
| | - Ismail Zaed
- 2Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele (MI), Italy
| | - Angelos G. Kolias
- 3Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital & University of Cambridge
- 4NIHR Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom; and
| | - Maurizio Fornari
- 1Department of Neurosurgery, Humanitas Clinical and Research Center, Rozzano (MI)
| | - Franco Servadei
- 2Humanitas University, Via Rita Levi Montalcini, Pieve Emanuele (MI), Italy
- 5World Federation of Neurosurgical Societies, Nyon, Switzerland
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Kim DH, Dagi TF, Bean JR. Neurosurgical Practice in Transition: A Review. Neurosurgery 2017; 80:S4-S9. [DOI: 10.1093/neuros/nyx008] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2016] [Accepted: 01/13/2016] [Indexed: 11/13/2022] Open
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Kim DH, Duco B, Wolterman D, Stokes C, Brace R, Solomon RA, Barbaro N, Westmark R, MacDougall D, Bean J, O’Leary J, Moayeri N, Dacey RG, Berger MS, Harbaugh R. A Review and Survey of Neurosurgeon–Hospital Relationships: Evolution and Options. Neurosurgery 2017; 80:S10-S18. [DOI: 10.1093/neuros/nyw171] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2016] [Accepted: 12/27/2016] [Indexed: 11/13/2022] Open
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McLaughlin N, Garrett MC, Emami L, Foss SK, Klohn JL, Martin NA. Integrating risk management data in quality improvement initiatives within an academic neurosurgery department. J Neurosurg 2015; 124:199-206. [PMID: 26230469 DOI: 10.3171/2014.11.jns132653] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT While malpractice litigation has had many negative impacts on health care delivery systems, information extracted from lawsuits could potentially guide toward venues to improve care. The authors present a comprehensive review of lawsuits within a tertiary academic neurosurgical department and report institutional and departmental strategies to mitigate liability by integrating risk management data with quality improvement initiatives. METHODS The Comprehensive Risk Intelligence Tool database was interrogated to extract claims/suits abstracts concerning neurosurgical cases that were closed from January 2008 to December 2012. Variables included demographics of the claimant, type of procedure performed (if any), claim description, insured information, case outcome, clinical summary, contributing factors and subfactors, amount incurred for indemnity and expenses, and independent expert opinion in regard to whether the standard of care was met. RESULTS During the study period, the Department of Neurosurgery received the most lawsuits of all surgical specialties (30 of 172), leading to a total incurred payment of $4,949,867. Of these lawsuits, 21 involved spinal pathologies and 9 cranial pathologies. The largest group of suits was from patients with challenging medical conditions who underwent uneventful surgeries and postoperative courses but filed lawsuits when they did not see the benefits for which they were hoping; 85% of these claims were withdrawn by the plaintiffs. The most commonly cited contributing factors included clinical judgment (20 of 30), technical skill (19 of 30), and communication (6 of 30). CONCLUSIONS While all medical and surgical subspecialties must deal with the issue of malpractice and liability, neurosurgery is most affected both in terms of the number of suits filed as well as monetary amounts awarded. To use the suits as learning tools for the faculty and residents and minimize the associated costs, quality initiatives addressing the most frequent contributing factors should be instituted in care redesign strategies, enabling strategic alignment of quality improvement and risk management efforts.
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Affiliation(s)
- Nancy McLaughlin
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles; and
| | - Matthew C Garrett
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles; and
| | - Leila Emami
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles; and
| | - Sarah K Foss
- Department of Risk Management, University of California, Los Angeles, California
| | - Johanna L Klohn
- Department of Risk Management, University of California, Los Angeles, California
| | - Neil A Martin
- Department of Neurosurgery, David Geffen School of Medicine, University of California, Los Angeles; and
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Senft C, Bink A, Franz K, Vatter H, Gasser T, Seifert V. Intraoperative MRI guidance and extent of resection in glioma surgery: a randomised, controlled trial. Lancet Oncol 2011; 12:997-1003. [PMID: 21868284 DOI: 10.1016/s1470-2045(11)70196-6] [Citation(s) in RCA: 536] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Intraoperative MRI is increasingly used in neurosurgery, although there is little evidence for its use. We aimed to assess efficacy of intraoperative MRI guidance on extent of resection in patients with glioma. METHODS In our prospective, randomised, parallel-group trial, we enrolled adults (≥18 years) with contrast enhancing gliomas amenable to radiologically complete resection who presented to Goethe University (Frankfurt, Germany). We randomly assigned patients (1:1) with computer-generated blocks of four and a sealed-envelope design to undergo intraoperative MRI-guided surgery or conventional microsurgery (control group). Surgeons and patients were unmasked to treatment group allocation, but an independent neuroradiologist was masked during analysis of all preoperative and postoperative imaging data. The primary endpoint was rate of complete resections as established by early postoperative high-field MRI (1·5 T or 3·0 T). Analysis was done per protocol. This study is registered with ClinicalTrials.gov, number NCT01394692. FINDINGS We enrolled 58 patients between Oct 1, 2007, and July 1, 2010. 24 (83%) of 29 patients randomly allocated to the intraoperative MRI group and 25 (86%) of 29 controls were eligible for analysis (four patients in each group had metastasis and one patient in the intraoperative MRI group withdrew consent after randomisation). More patients in the intraoperative MRI group had complete tumour resection (23 [96%] of 24 patients) than did in the control group (17 [68%] of 25, p=0·023). Postoperative rates of new neurological deficits did not differ between patients in the intraoperative MRI group (three [13%] of 24) and controls (two [8%] of 25, p=1·0). No patient for whom use of intraoperative MRI led to continued resection of residual tumour had neurological deterioration. One patient in the control group died before 6 months. INTERPRETATION Our study provides evidence for the use of intraoperative MRI guidance in glioma surgery: such imaging helps surgeons provide the optimum extent of resection. FUNDING None.
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Affiliation(s)
- Christian Senft
- Department of Neurosurgery, Goethe University, Frankfurt, Germany.
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