Two generations of neurosurgery chairs ago — in the late 1980s — the top job in New York City-based NYU Langone Health’s neurosurgery department paid about the same as the No. 2 job at Goldman Sachs, said John Golfinos, MD, the department’s current chair.
“Our compensation has not changed since that day,” Dr. Golfinos said. “[Goldman Sachs] has gone a thousandfold.”
Surgeons consider the decline in physician reimbursement as a major concern in the industry. Dr. Golfinos said there is a reckoning headed for neurosurgery and other high-acuity subspecialties as reimbursement keeps sliding.
Physician fees have dropped roughly 30% over the past 20 years, he said, and more surgeons are either setting up physician-owned ASCs to capture facility fees or forgoing insurance entirely.
“There are a lot of neurosurgeons, especially around, you know, and in the suburbs of New York, who don’t take any insurance, and they live off of, you know, this out-of-network thing,” he said.
Dr. Golfinos put a number on the squeeze. He said Medicare will pay physicians about $2,200 for a craniotomy to remove a brain tumor. Private insurers typically negotiate rates around 150% of Medicare. This may sound like a premium, he said, but still is not enough.
“That’s 100% of nothing,” he said. “That’s nothing.”
Dr. Golfinos said the strain lands hardest away from large academic medical centers, and smaller hospitals will struggle to keep paying neurosurgeons enough to cover emergency rooms and meet level 1 trauma center requirements.
Training a neurosurgeon takes seven years plus fellowship, he noted, and asked: “Who’s going to keep doing that if the returns aren’t there?”
Dr. Golfinos predicted CMS will not budge until physicians start leaving Medicare in large numbers.
“It’s going to reach a crisis point sooner rather than later.”
At the Becker’s 32nd Annual Meeting: The Business and Operations of ASCs, taking place October 29-31 in Chicago, ASC leaders, surgeons and healthcare executives will explore strategies to drive growth, enhance operational performance, navigate reimbursement challenges and prepare for the future of ambulatory surgery. Apply for complimentary registration now.
