Neurosurgery
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Functional recovery following supinator motor branch transfer requires further investigation. ⋯ Supinator motor branch transfer allows for faster recovery and is a more effective procedure for restoring finger extension in C7-T1 brachial plexus palsies.
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The purpose of neurosurgical education is to teach the clinical knowledge and surgical skills necessary to become a neurosurgeon. Another goal is to inculcate the principles of the scientific method. ⋯ At the same time, our healthcare system is undergoing a rapid socioeconomic transition in organization and payment models, which traditionally has not been a focus of formal teaching. A 2008 survey conducted by the Council of State Neurosurgical Societies found that graduating residents felt inadequately prepared in areas like contract negotiation, practice evaluation, and management.
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The passage of the Affordable Care Act saw the creation of Accountable Care Organizations (ACOs), a new approach to healthcare delivery moving from fee-for-service toward population health. This paper presents a case study of the Memorial Hermann ACO (MHACO), launched in response to the Medicare Shared Savings Program, with goals to align physician and hospital incentives, practice evidence-based medicine, develop care coordination, and increase efficiency. Building blocks included an affiliated primary care network, a clinical integration program (involving shared electronic medical record platforms and quality data reporting), and significant investments in information technology. ⋯ Although ACOs to date have focused on primary care, the future will increasingly involve specialists. At Memorial Hermann, neurosurgeons took an early role in forming collaborative partnerships with the hospital, and started programs that served as precursors to the ACO model. This paper ends with an overview of ACO development, likely changes going forward, and a discussion of the role of specialists in general, and of neurosurgeons in particular.
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Healthcare delivery is evolving rapidly with an increasing emphasis on the concept of "value." At the same time, neurosurgeons are disproportionately working in employed positions where external definition of value becomes directly linked with compensation, work environment, and career satisfaction. Few neurosurgeons have an understanding of the various ways in which value is and can be defined and there are limited resources to assist in this realm. This paper covers the essential value concepts of National Standards, Pitfalls of National Standards, Call Coverage Compensation, Valuation Through Demand, Value Beyond Productivity, and Neurosurgical Value in the Accountable Care Organization Era. This framework should help neurosurgeons better understand critical trends impacting practice across the country.
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The Health Care Reform Act has fostered a shift toward capitation and shared risk among providers to improve quality and reduce the escalating costs of healthcare. Like all physicians, neurosurgeons are increasingly being incentivized to participate in efforts to streamline care through the use of surgical pathways to reduce hospital length of stay and prevent readmissions. ⋯ This paper predicts and advocates for a further broadening of neurosurgery participation from programs that reward physicians for helping to prevent a high-risk patient's need for surgery to management of postacute rehabilitation. It also introduces the concept of risk reduction more generally at the community level through collaborative interventions that improve health through changes to the built environment, innovations in transportation, and improved access to healthy food and recreation opportunities.