Upcoming Challenges for Neurologists in the United States

With the rapidly changing economy, new healthcare laws, and a plethora of cuts from the government, neurologists and their practices should expect a severe decrease in revenue. According to JAMA Neurology Volume 70, Number 9, the sweeping changes due to Obamacare are effecting many medical institutions and practices, but for a number of reasons, neurology is in a crisis of its own. To give you an idea of impact of current neurological practices, here are some of the big cuts that’ve already been implemented:

"...as of January 1, 2013, the Centers for Medicare and Medicaid Services, by regulation, reduced the payment for nerve conduction testing services by more than 50%. Jonathan Blum, a Centers for Medicare and Medicaid Services administrator, indicated that these cuts reduce total neurologic revenue by 7% on average. Implemented March 1, 2013, sequestration cuts further reduced Medicare payments to physicians by 2%. Because the typical neurologic practice has an overhead percentage of greater than 50%, the 9% cut to revenue translates to a greater than 18% reduction in neurologist income.”
…"every deficit reduction proposal targets GME payments. The most prominent, the 2010 Simpson/Bowles bipartisan commission (updated in 2012), proposed a 60% reduction in GME payments. President Barack Obama’s recently released 2014 budget recommends a $780 million cut to GME payments, approximately a 7% cut."

Not only are current small neurology practices being short-changed, but those looking to train to become neurologists are also in trouble:

"As neurologic practices struggle to stay afloat, the viability of training programs is also imperiled. In addition to the loss of clinical revenues, 2 other sources of revenue that support the educational mission are at risk: hospital facility fees and federal graduate educational payments. The facility fee—an additional charge for outpatient services charged by hospitals that materially adds to the reimbursement for these services—is on the hit list for deficit reduction."

As if these cuts weren’t enough, research grants will also be greatly reduced:

”...new grants are projected to be sharply reduced to 17% to 18% of the proposals. Successful awardees now comprise only half of the percentage of those who succeeded in attaining them in the 1980s.”
“…Academic and research programs can find replacement for some of the lost federal revenues through well-coordinated efforts to attract charitable support.”
“...GME funding of neurology training must be protected. Finally, the president’s announced initiative provides a key opportunity to educate the public and Congress as to the need for research and access to care for this patient population.”

Unfortunately in rough economic times, science and medicine tend to get defunded. Neurological disorders are prevalent throughout the world, and as a society we understand that they need serious research and treatments. In your next email, letter, or call to your representatives, consider pressuring them to support laws that strengthen neurological science, treatments, and practices.

Visit JAMA Neurology’s site to susbcribe to their journal for further reading and sources. JAMA Neurology September 2013 Volume 70, Number 9 page 1097, 1098 written by Orly Avitzur, MD, MBA and Bruce Sigsbee, MD, MS.