The care provided by neurologists more often consists of providing consultations to patients than performing tests and procedures, according to a study released last Wednesday. However, Medicare reimburses neurologists at a lower rate for these face-to-face meetings, compared to services like a surgery or biopsy.

Led by Neurology Prof. Kevin Kerber, the study reviewed all Medicare payments to neurologists in 2012. The study found 60 percent of the Medicare reimbursements paid to neurologists were classified as “evaluation and management services.” These usually include the doctor and the patient discussing conditions and the best methods of treatment or following up on chronic conditions.

Surgeons, for example, report providing far fewer of these services, ranging between 15 and 51 percent of their reimbursements.

Neurology Prof. Lesli Skolarus, one of the study’s researchers, said the majority of neurologists’ work is not procedural or surgical, but rather, involves meeting with patients.

However, Medicare determines reimbursement formulas based on a specialties — such as surgery or internal medicine — instead of how doctors actually spend their time. The study found that face-to-face meetings between neurologists and their patients are not compensated as much as they are for other types of physicians.

“I think that as a payment system, (Medicare is) designed now so that face-to-face services are generally not reimbursed as much as doing procedures,” she said. “As neurologists, many of our services are not amenable to treatment by procedure, but are highly valued in these encounters. So we think that should be thought more carefully about. What’s the value? We’re certainly not doing procedures for many of our neurologic patients.”

Kerber said the study provided information about the makeup of the neurological workforce. He said this data could serve as a tool to determine how neurologists are paid and incentivized in relation to the way they practice medicine.

“Prior to the study, there was very little information available to actually understand neurology practice in the United States in terms of payments and types of services rendered,” he said. “We had a unique opportunity to look at that given the public release of the Medicare data regarding all physicians paid by Medicare.”

Skolarus said health care policies should value the services different types of doctors provide, and that she hopes this study can provide data to show that the services neurologists provide are more often base din evaluation and management.

“There’s a Medicare bonus and a Medicaid bump for certain specialties to receive extra payment for face-to-face time, and neurology was not one of those specialties,” Skolarus said. “We hoped that this would provide a data point for both neurologists and policy-makers to show that neurologists look more like primary care specialties than they look like surgical specialties.”

In addition to the complexities associated with neurological diseases, Skolarus said medical treatments for neurological patients are often finely tuned and adjusted during face-to-face visits.

Kerber and Skolarus both said complex diseases like Alzheimer’s and Parkinson’s often require an increased level of attention from the doctor. Because face-to-face interactions are important, they should be properly compensated by Medicare. The researchers said this is a primary reason why it’s important to look at Medicare policy in the context of how doctors spend their time.

“I think that the goal of our study and what we’re finding is that we think as healthcare reform comes about, that the value of what different specialties do should be carefully determined,” Skolarus said. “There’s certainly value in both doing procedures and doing more face-to-face patient contact. Those should be determined for what they’re worth and not in such black and white.”

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