Journal of neurosurgery
-
Journal of neurosurgery · Aug 2017
Impact of insurance precertification on neurosurgery practice and health care delivery.
OBJECTIVE Insurance preauthorization is used as a third-party tool to reduce health care costs. Given the expansion of managed care, the impact of the insurance preauthorization process in delaying health care delivery warrants investigation through a diversified neurosurgery practice. METHODS Data for 1985 patients were prospectively gathered over a 12-month period from July 1, 2014, until June 30, 2015. ⋯ Predictably, Medicare insurance was protective against a delay in surgery (p = 0.001). CONCLUSIONS Choice of insurance provider and instrumentation procedures were independent risk factors for a delay in insurance preauthorization. Neurosurgeons, not just policy makers, must take ownership to analyze, investigate, and interpret these data to deliver the best and most efficient care to our patients.
-
Journal of neurosurgery · Aug 2017
A systematic review of 30-day readmission after cranial neurosurgery.
OBJECTIVE The 30-day readmission rate has emerged as an important marker of the quality of in-hospital care in several fields of medicine. This review aims to summarize available research reporting readmission rates after cranial procedures and to establish an association with demographic, clinical, and system-related factors and clinical outcomes. METHODS The authors conducted a systematic review of several databases; a manual search of the Journal of Neurosurgery, Neurosurgery, Acta Neurochirurgica, Canadian Journal of Neurological Sciences; and the cited references of the selected articles. ⋯ Complications arising during or after neurosurgical procedures were a prime reason for readmission. Race, comorbidities, and longer hospital stay put patients at risk for readmission. CONCLUSIONS Although readmission may be an important indicator for good care for the subset of acutely declining patients, neurosurgery should aim to reduce 30-day readmission rates with improved quality of care through systemic changes in the care of neurosurgical patients that promote preventive measures.
-
Journal of neurosurgery · Aug 2017
Comparative StudyAre Hispanic patients with subarachnoid hemorrhage treated differently in border states than in nonborder states?
OBJECTIVE Recent studies have found an underutilization of in-hospital procedures in treatments of Hispanic patients admitted with coronary artery disease in states along the US-Mexico border ("border states"). The purpose of this study was to determine any treatment disparities between patients treated for subarachnoid hemorrhage (SAH) in border and nonborder states and whether this disparity was associated with differential hospital charges. METHODS Using the National (Nationwide) Inpatient Sample, the authors retrieved data of Hispanic and non-Hispanic patients who were admitted in 2011 for SAH in a border state (California, Arizona, New Mexico, and Texas) or nonborder state (the remaining 46 US states). ⋯ In the nonborder states, the rates of surgical treatment were similar for Hispanic and non-Hispanic patients (14.0% vs 15.6%, p = 0.6). Hispanic patients with SAH were billed significantly higher in-hospital charges in border states than in nonborder states ($219,260 and $192,418 [US dollars], respectively, p < 0.001). CONCLUSIONS Use of surgical treatments for Hispanic patients with SAH residing in border states has a unique pattern, which significantly increases in-hospital charges in this patient population.