112 Impact of COVID-19 on Neurosurgical Utilization and Reimbursement

Abstract

INTRODUCTION: The COVID-19 pandemic required significant adaptations in healthcare operations to preserve limited resources and mitigate viral spread. This included the postponement of non-emergent services, including elective surgical procedures, in the Spring/Summer of 2020. Additionally, patients may have avoided or delayed medical care even after the mandatory postponement due to fear of infection. METHODS: We analyzed public data summarizing neurosurgical services provided to Medicare beneficiaries. Annual number of services rendered, beneficiaries treated, and payments received by neurosurgeons were compared between 2019 and 2020 via Students’ T-test and Wilcoxon Rank-Sum tests. Procedures were categorized by location, pathology, and/or approach to identify patterns in the types of procedures most heavily impacted. Pearson's linear regression was used to determine the relationship between the stringency of Covid-19 restrictions and the change in services. RESULTS: From 2019 to 2020, there was a 12.27% decrease in the aggregate number of services rendered by neurosurgeons corresponding to a 12.48% decrease in total Medicare payment. In a matched cohort of 4,649 neurosurgeons active in both 2019 and 2020, the average number of annual services per neurosurgeon declined by 12.40% with a concomitant decrease in payment by 12.77%. This corresponded to an average per-neurosurgeon loss of $17,455.43 in Medicare-related income. Nationally, functional, sellar/parasesellar, and open cerebrovascular surgeries exhibited the largest reduction in volume (all >20%). In contrast, endovascular procedures only declined by 5.5%. There was a weak but significant trend toward larger reduction in volume in states with more stringent Covid-19 restrictions (R = -0.357, p = 0.010). CONCLUSIONS: Neurosurgeons experienced significant reductions in case volume and income during the first year of the Covid-19 pandemic. The magnitude of impact appears to be influenced, at least in part, by the stringency of state-level restrictions.