Practice and payment trends in neurology in 2012

Improving Access to Tertiary Movement Disorders Subspecialty Care: A Team Model Born From the COVID-19 Crisis

Patient demand continues to outpace growth of the neurology workforce, especially in its subspecialties such as movement disorders. Various strategies have been deployed to address this. The COVID-19 pandemic accentuated the mismatch by propelling telemedicine and access demands to the forefront. Previously, we reported improving general neurology access using a physician-advanced practice provider (APP) team model. Here, we share our experiences of piloting a similar model in subspecialty care (movement disorders) between September 1 and December 17, 2020. Before the pilot, the wait time to be seen by movement disorders subspecialists exceeded four months. Our data show marked improvement in new patient access (23.8% improvement as well as 214% increase in number of new patients seen) with excellent patient acceptance. Our approach and the lessons learned may be useful to address access for other neurology subspecialties.

Effects of Fragmentation and the Case for Greater Cohesion in Neurologic Care Delivery

GOALS

To define fragmentation in neurologic care delivery, explain the positive and negative drivers in neurologic practice that contribute to fragmentation, illustrate situations that increase fragmentation risk, emphasize the costs and impact on both patients and providers, and propose solutions that allow for more cohesive care.

WORK GROUP

The Transforming Leaders Program (TLP) class of 2020 was tasked by American Academy of Neurology (AAN) leadership to identify the leading trends in inpatient and outpatient neurology and to predict their effects on future neurologic practice.

METHODS

Research material included AAN databases, PubMed searches, discussion with topic experts, and AAN leadership.

RESULTS

Trends in care delivery are driven by changes in the work force, shifts in health care delivery, care costs, changes in evidence-based care, and patient factors. These trends can contribute to care fragmentation. Potential solutions to these problems are proposed based on care models developed in oncology and medicine.

LIMITATIONS

This article shares our opinions as there is a lack of evidence-based guidelines for optimal neurologic care delivery.

A Shortage of Neurologists - We Must Act Now: A Report From the AAN 2019 Transforming Leaders Program

In nearly every US state, a large mismatch exists between the need for neurologists and neurologic services and the availability of neurologists to provide these services. Patients with neurologic disorders are rising in prevalence and require access to high-level care to reduce disability. The current neurology mismatch reduces access to care, worsens patient outcomes, and erodes career satisfaction and quality of life for neurologists as they face increasingly insurmountable demands. As a community, we must address this mismatch in the demand and supply of neurologic care in an aggressive and sustained manner to ensure the future health of our patients and our specialty. The American Academy of Neurology has multiple ongoing initiatives to help reduce and resolve the existing mismatch. With the intent of raising awareness and widening the debate nationally, we present a strategic plan that the Academy could implement to coordinate and expand existing efforts. We characterize the suggested strategies as shaping the demand, enhancing the workforce, and advocating for neurologist value. The proposed framework is based on available data and expert opinion when data were lacking. Prioritization of strategies will vary by geography, practice setting, and local resources. The time to act is now to allow concerted effort and targeted interventions to avert this looming public health crisis.

How neurologists are paid: Part 1: The Medicare payment system

Neurologists are facing yearly reductions in reimbursement for rendered services. These reductions arise from changes by Medicare, Medicaid, and third-party payers to achieve cost savings. In Part 1, we discuss reimbursement for office visits and procedures, the relative value scale, the conversion factor used by Medicare to transform work into payments, and the recently repealed sustainable growth rate. The establishment of new codes for transitional care and chronic care management may augment the salaries of neurologists who care for patients with chronic conditions. Medicare's recent elimination of payment for consultations and the bundling of nerve conduction studies have dramatically affected reimbursement. Large discrepancies remain between compensation for procedures and office visits.

Recovery audits: Practical update for neurology practices

Recovery Audit Contractors (RACs) are contracted by the federal government to review providers' medical billing. Experience has demonstrated substantial savings to the strapped Medicare fund, fueling increased scrutiny. RAC audits are constrained to published focus areas, and its targeted approach makes use of sophisticated analytics. Although some of the analyses used by the RACs may be proprietary, much of the auditing process is transparent, allowing providers to prepare their practices in advance of audits. This article reviews the current state of RAC auditing and offers strategies to minimize financial pain and leverage the process for competitive advantage.