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Background: Trends in Medicare billing and procedural reimbursement for outpatient office visits remain unclear within the field of neurosurgery., Objective: To analyze financial trends of neurosurgeon reimbursement for Medicare office visits in 2010 compared to 2018., Methods: The 2010 and 2018 physician/supplier files from the Centers for Medicare and Medicaid Services website were utilized. All payments submitted by neurosurgeons (provider ID 14) were included. Trends in office visit Current Procedural Terminology codes 99201 to 99205 and 99211 to 99215 were analyzed., Results: Neurosurgeons billed for 1 109 979 office visits (463 611 h) in 2010 and Medicare denied 63 704 payments (totaling $11 205 283). Neurosurgeons billed for 1 189 046 office visits (508 526 h) in 2018 and Medicare denied 57 048 payments (totaling $15 103 879). This is a 7.1% increase in total neurosurgery office visits billed to Medicare, 9.7% increase in total office hours, and 34.8% increase in the payment amounts denied over 8 yr. Furthermore, after adjusting for inflation, the average amount paid to physicians by Medicare decreased by 8.3% per office visit. Additionally, Medicare paid 36.1% of the total neurosurgeon submitted charge amount for all office visits in 2010 but paid only 27.8% in 2018 (-8.3%)., Conclusion: Neurosurgeons are performing more office visits and billing for more time with patients. Meanwhile, Medicare has been paying physicians less per office visit, denying higher amounts of payments and reimbursing a decreasing percentage of submitted charges for office visits. An understanding of these trends is necessary to ensure continued equity and quality access to neurosurgical care in the United States., (© Congress of Neurological Surgeons 2021.)

Background: Practice consolidation in healthcare has widespread consequences for providers and patients. Although many studies describe this phenomenon in various medical specialties, no such analysis has been performed in neurosurgery specifically. The goal of this study was to assess the trends in the size of U.S. neurosurgery practices over a 5-year period., Methods: Neurosurgery practice characteristics were obtained from the Medicare Physician Compare database from March 2014 through October 2019 on the Centers for Medicare & Medicaid Services Website. Neurosurgeons were separated on the basis of their practice size. Group practice sizes ranged from solo practitioner practice to large multispecialty groups and health organizations. Eight groups were identified (1 or 2, 3-9, 10-24, 25-49, 50-99, 100-499, 500-999, and ≥1000 members). Additionally, neurosurgery practices were analyzed across the 4 U.S. geographical regions to understand changes in practice size and distribution., Results: The percentage of neurosurgeons in smaller practices of 1 or 2 members decreased, from 20.09% to 13.05%; 3-9 members, from 17.79% to 9.41%; and 10-24 members, from 10.53% to 8.0%. The largest increase was seen in health organizations of 1000 members or more, with an increase from 9.85% to 22.84%., Conclusions: This study shows that over the past 5 years, a substantial trend toward increasing practice sizes has evolved. The effect of the differences in practice size should be examined to determine the large-scale impacts on patient care, payment models, and healthcare access, in addition to neurosurgeon compensation, and satisfaction., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Background: As the uncertainty surrounding the future of U.S. health care policy intensifies, political advocacy and campaign contributions have become increasingly relevant. This study describes the trends of political contributions of U.S. neurosurgeons from the years 2003-2019., Methods: Individual contribution data from 2003-2019 were obtained from the Federal Election Commission website. Contributions were filtered for occupation lines matching either "neurosurg," "neurologic surgeon," or "neurological surgeon." Each contribution is designated to a recipient committee associated with a political candidate or group. The party designations of these committees were used to catalogue donations as "Republican," "Democratic," or "Independent.", Results: From 2003-2019 a total of 9242 political donations were made by self-identified neurosurgeons amounting to $8,469,121. Most of these contribution dollars were directed to Independent committees (47.9%). Of all Independent contribution dollars from 2005-2019, 95.9% were directed to the American Association of Neurological Surgeons Political Action Committee. The total number of unique contributions increased from 442 contributions in 2003 to 650 in 2019. Democrats experienced the most substantial increase in support, from 4.8% of all contribution dollars in 2003 to 26.3% in 2019. Republican support was noted to be more widespread across the United States compared with Democratic support., Conclusions: Political contributions from U.S. neurosurgeons have increased steadily over time. Donations were largely Independent but became increasingly partisan in recent years. Overall, this displays an increase in political involvement among the neurosurgeon community. Future studies are warranted into how this involvement translates to representative health policy., (Copyright © 2020 Elsevier Inc. All rights reserved.)

Objective: We sought to determine the proportion and number of female neurosurgeons in the workforce at different stages of practice., Methods: The Physician Compare National Downloadable File data set was obtained from the Centers for Medicare & Medicaid Services for physicians who indicated "neurosurgery" as their primary specialty. Physician duplicates, physicians with no listed medical school graduation year, and physicians expected to be in residency (graduation years 2013-2019) were removed, yielding 4956 neurosurgeons. Five-year intervals were used to measure the number of male and female neurosurgeons by different stages of their careers. For example, graduates from years 2008-2012 were expected to be in their first 1-5 years of practice., Results: There were 405 female (8.2%) and 4551 male (91.8%) neurosurgeons. At 1-5 years of practice, 13.8% (105/760) were women; 6-10 years, 11.5% (94/820) women; 11-15 years, 8.9% (64/720) women; 16-20 years, 8.7% (59/682) women; 21-25 years, 7.4% (46/619) women; 26-30 years, 3.8% (20/520) women; 31-35 years, 3.6% (15/413) women; and 36 years or more, 0.5% women (2/422). The number of female neurosurgeons varied among states, ranging from 0 in Hawaii to 53 in California. The states with the lowest percentage of female neurosurgeons were Hawaii (0%), Oklahoma (3.1%), and Nevada (3.6%). The states with the highest percentage of female neurosurgeons were New Hampshire (20.0%), Vermont (16.7%), and Rhode Island (15.8%)., Conclusions: The number of practicing female neurosurgeons within the United States is increasing, as shown by the growing percentage of women who are earlier in their surgical careers., (Copyright © 2020 Elsevier Inc. All rights reserved.)