title: Neurosurgeons' responses to changing Medicare reimbursement.
abstract: OBJECTIVE
  Medicare reimbursement for physician services has been declining even as the number of Medicare enrollees has been increasing. The number of Medicare participants will only continue to grow as the American population ages and the Patient Protection and Affordable Care Act goes into effect. Efforts to increase reimbursement for physician services through Medicare are often met with data showing that most neurosurgeons continue to participate in the program despite these cutbacks. To better understand this dichotomy, practicing neurosurgeons were surveyed to gauge their response to cutbacks in the Medicare program beyond just their participation status.
  
  
  METHODS
  An Internet-based survey invitation was emailed to 3469 practicing neurosurgeons. Reminder emails were sent at intervals over several weeks to help increase the response rate.
  
  
  RESULTS
  Among respondents, an overwhelming percentage (96.8%) participated in Medicare. The neurosurgeons indicated that about one-third of their patient population was covered by Medicare. They also reported limiting the number of Medicare patients they see through a variety of mechanisms: only seeing Medicare patients with a specific diagnosis or from certain referring physicians or limiting the number of appointment slots for Medicare patients. Many respondents stated that further declines in Medicare reimbursement would lead to a reduction in their participation.
  
  
  CONCLUSIONS
  While most responding neurosurgeons do participate in the Medicare program, a substantial proportion modulates their participation through a variety of mechanisms. These barriers to care access for Medicare patients are only expected to become greater if further declines in reimbursement are implemented through the program.
authors.affiliation: Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; and.
authors.forename: Joshua M
authors.initials: JM
authors.lastname: Rosenow
authors.forename: Katie O
authors.initials: KO
authors.lastname: Orrico
mesh_terms: D001291:Attitude of Health Personnel; D003625:Data Collection; D006801:Humans; D006278:Medicare; D009493:Neurosurgery; D058991:Patient Protection and Affordable Care Act; D011216:Practice Management, Medical / Q000458:organization & administration; D010818:Practice Patterns, Physicians' / Q000458:organization & administration; D012051:Reimbursement Mechanisms; D014481:United States
keywords: ACO = accountable care organization; CMS = Centers for Medicare and Medicaid Services; Medicare; RBRVS = resource-based relative value scale; RVU = relative value unit; SGR = sustainable growth rate; access to care; neurosurgery; reimbursement