Medicare payment cuts may impact patients’ access to quality neurosurgical care

As lawmakers continue to wrestle with how best to reform the Medicare physician payment system, the results of a new survey by the American Association of Neurological Surgeons (AANS), the Congress of Neurological Surgeons (CNS), and the Council of State Neurosurgical Societies (CSNS) paint a troubling picture for patients if drastic Medicare physician payment cuts continue.

The national survey of neurosurgeons reveals that while most neurosurgeons do currently participate in Medicare and see a fair number of Medicare patients, many are now limiting their Medicare practice in some way. The nation’s brain and spine surgeons are therefore urging Congress to permanently repeal the flawed payment system, known as the sustainable growth rate (SGR) formula, to prevent the further erosion of seniors’ access to timely, quality neurosurgical care. The AANS and CNS do not support temporary “fixes” to this payment problem and are calling on lawmakers to reject short-term “solutions” that will only make it more costly to repeal the SGR in the future.

“It’s obvious from the responses we received in this survey that low Medicare payments to neurosurgeons is ultimately having a significant effect on the very patients who truly need neurosurgical care. Lawmakers need to ask, ‘Is this the future we want for America’s seniors?’ and take action immediately”

“These results really do paint a bleak path we are going down. 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,” said Troy M. Tippett, MD, President of the AANS. “It is crucial that Congress pass legislation immediately to address the decline in Medicare payments so that we can alter this course.”

TOP FINDINGS

Over the past three to five years, neurosurgeons have observed a number of key changes in the environment for Medicare patients including:

• It has gotten harder to refer patients to certain medical and surgical specialists (67.2%).
• More physicians are referring Medicare patients with complex problems to other doctors (64.8%).
• Many Medicare patients now have to travel further to get needed care (63.7%).
• Neurosurgeons are reducing the number of Medicare patients in their practice due to low reimbursement (59.2%).

In addition, timely access to neurosurgical care is a growing problem, to wit:

• The average waiting time for a patient appointment is 24.1 days for new patients and 19.5 days for established patients.
• Those neurosurgeons who limit the number of Medicare appointment slots do so through the scheduling process (42%), by limiting the overall number of Medicare patients they treat (35%), or by selecting patients based on their geographic location (10%).

Furthermore, if Medicare payments continue to be cut, survey results show that patients’ access to care will be significantly affected:

• 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 will no longer take any new Medicare patients.
• Over fifty percent of neurosurgeons will stop providing certain services and nearly fifty-three percent will reduce the time they spend with Medicare patients.

Survey results also show 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. In the future, access to neurosurgical care for new and established Medicare patients in the Southwest and Southeast, will also 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.

“It’s obvious from the responses we received in this survey that low Medicare payments to neurosurgeons is ultimately having a significant effect on the very patients who truly need neurosurgical care. Lawmakers need to ask, ‘Is this the future we want for America’s seniors?’ and take action immediately,” observed CNS President Gerald E. Rodts, MD.

William E. Bingaman, MD, Chair of the CSNS, added, “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.’ 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 for patients and physicians alike, and the AANS, CNS, and CSNS study simply reinforces that notion.”

In conclusion, a significant number of survey respondents from big cities to small towns acknowledged that if there are further cuts in Medicare reimbursement, they will have no choice but to reduce the number of Medicare patients they treat and/or make other changes in their practices that will affect seniors’ timely access to neurological care. If Congress doesn’t take action, a twenty-two percent pay cut for all physicians is scheduled to take effect as of March 1.