Hopkins Benjamin S, Dallas Jonathan, Guerra Gage, Hofmann Hayden L, Ordon Matthew, Nguyen Vincent N, Caravan Bassir, Liu John, Zada Gabriel, Mack William J
1Department of Neurological Surgery, Keck School of Medicine at University of Southern California, Los Angeles; and.
2Department of Neurosurgery, Cedars Sinai, Los Angeles, California.
J Neurosurg. 2024 Nov 29;142(4):1163-1175. doi: 10.3171/2024.7.JNS24388. Print 2025 Apr 1.
Determining the value of a neurosurgeon is complex. Services provided by neurosurgeons have a range of interested parties-from a patient's singular health interest to a community catchment area rendering on-call emergency services. Such complexity makes it difficult to determine and define value. As healthcare reimbursement changes continue to transition further toward value-based/bundled payments, such determinations remain difficult and confusing. Given these factors, now more than ever before, neurosurgeons need to be active participants in the evolving discussions surrounding healthcare advocacy, value, and compensation in an ever-evolving and convoluted system. The objective of this study was to review and present current trends within the evolving landscape of healthcare economics and their impacts on the perceived value of neurosurgical services.
A systematic review regarding payments and compensation within neurosurgery was performed using a key term search. Additionally, a neurosurgical value model for hospitals was created using Medicare reimbursement methods to attempt to determine the financial contribution of a single neurosurgeon to a hospital system. Furthermore, Internal Revenue Service (IRS) form 990 tax filings from 5380 organizations were examined for comparative trends in profits and revenue on a hospital-wide basis.
Mean and median annualized excess hospitalization revenue from a neurosurgeon over the same number of equal medical admissions was $5,120,533 and $5,141,160, respectively. For private practice groups, the annualized mean and median yearly hospital revenue over a comparable medical admission was calculated to be $1,539,704 and $1,902,555, respectively. For hospital-employed neurosurgeons, the respective addition of Medicare part B payments increased the mean and median values to $2,249,552 and $2,612,403, respectively. Analysis of nonprofit hospital IRS form 990 filings revealed a substantial increase in executive compensation and hospital revenue since 2011. Neurosurgeon median earnings over a similar period, reported through surveys, exhibited varied increases, but significant reporting variation exists.
Medical compensation continues to evolve toward more value-driven methods. Value created as a neurosurgeon is complex, but it should not be underestimated as a key driver of hospital revenue, with up to $2.6 million created annually from neurosurgical hospital admissions. Further discussion is needed to elucidate alternative innovative payment strategies to ensure physicians remain active in the evolving structure of our healthcare system.
确定神经外科医生的价值很复杂。神经外科医生提供的服务涉及一系列利益相关方，从患者个人的健康利益到提供随叫随到急诊服务的社区服务区域。这种复杂性使得难以确定和界定价值。随着医疗保健报销方式继续进一步向基于价值的/捆绑式支付转变，此类确定仍然困难且令人困惑。鉴于这些因素，神经外科医生现在比以往任何时候都更需要积极参与围绕不断演变且错综复杂的医疗保健体系中的医疗倡导、价值和薪酬的讨论。本研究的目的是回顾并呈现医疗保健经济学不断演变的格局中的当前趋势及其对神经外科服务感知价值的影响。
使用关键词搜索对神经外科领域内的支付和薪酬进行了系统综述。此外，利用医疗保险报销方法创建了医院神经外科价值模型，试图确定单个神经外科医生对医院系统的财务贡献。此外，还检查了5380个组织的美国国税局（IRS）990表格纳税申报单，以了解全医院范围内利润和收入的比较趋势。
在相同数量的同等医疗入院病例中，神经外科医生的平均年化超额住院收入和中位数年化超额住院收入分别为5,120,533美元和5,141,160美元。对于私人执业团体，在可比医疗入院病例上的年化平均和中位数年度医院收入分别计算为1,539,704美元和1,902,555美元。对于受雇于医院的神经外科医生，医疗保险B部分支付的相应增加使平均值和中位数分别增至2,249,552美元和2,612,403美元。对非营利性医院IRS 990表格纳税申报单的分析显示，自2011年以来高管薪酬和医院收入大幅增加。通过调查报告的同期神经外科医生的中位数收入呈现出不同程度的增长，但存在显著的报告差异。
医疗薪酬继续朝着更具价值驱动的方法演变。作为神经外科医生所创造的价值很复杂，但作为医院收入的关键驱动因素，不应被低估，神经外科住院病例每年可创造高达260万美元的收入。需要进一步讨论以阐明替代性创新支付策略，以确保医生在不断演变的医疗保健系统结构中保持积极参与。
