Abstract
IntroductionGrowth of surgical caseload among specialties with a large contribution margin is an important financial objective for hospitals. In this study, we examined the diversity of referral patterns to a neurosurgeon over an eight-year interval and examined practice attributes related to surgical growth.MethodsThe electronic records of all patients undergoing an intracranial surgical procedure between August 2011 and August 2019 by an academic neurosurgeon were reviewed retrospectively. The Herfindahl-Hirschman index (HHI) was used to assess the distribution of referrals among community physicians who referred such patients; a value of HHI <0.15 indicates diversity. The yearly HHI trend was evaluated using meta-regression.ResultsThe neurosurgeon’s brain surgery caseload progressively increased on an annual basis from 1.4 to 12.5 cases per week between 2012 and 2018. Among the 1540 cases referred by 1775 different physicians, 78% were from three counties in southeast Florida and 8.1% from two counties in southwest Florida. The HHI declined between 2013 and 2018 by 0.023 per year (0.0046 standard error [SE], p = 0.0073) with the estimated value 0.0063 (0.0014 SE) < 0.15 in 2018 (p < 0.0001). The findings indicate that the base of referring physicians was highly diverse and that growth in caseload was accompanied by significantly less concentration of referrals.ConclusionSurgical growth in the neurosurgeon’s practice resulted from a small number of referrals from many physicians, not from many referrals from a small number of physicians. Few physicians referred a sufficient number of patients to warrant attribution of the referral itself to personal knowledge of their patients' eventual outcomes. Rather, factors promoting timely access to patient care appear to have been the driving force for growth.
Highlights
MethodsThe electronic records of all patients undergoing an intracranial surgical procedure between August 2011 and August 2019 by an academic neurosurgeon were reviewed retrospectively
Growth of surgical caseload among specialties with a large contribution margin is an important financial objective for hospitals
We examined the diversity of referral patterns to a neurosurgeon over an eight-year interval and examined practice attributes related to surgical growth
Summary
The electronic records of all patients undergoing an intracranial surgical procedure between August 2011 and August 2019 by an academic neurosurgeon were reviewed retrospectively. The University of Miami Institutional Review Board approved this retrospective study (IRB #20160437) with a waiver of consent. We relied on an Excel worksheet (Microsoft, Redmond, WA) maintained by the neurosurgeon (RJK) for all his patients who underwent brain surgery between January 1, 2012, and August 1, 2019, at the University of Miami Hospital. The patient’s name, date of surgery, the procedure performed, referring physician, and referring physician’s postal code were reviewed. The yearly number of new patients referred by each physician was tabulated. Surgical logs from the electronic health system (Epic Systems, Verona, WI) were examined to determine if a new patient underwent brain surgery within 365 days of the initial evaluation. Travel times were estimated using the Google Distance Matrix application programming interface (Google, Mountain View, CA) [13,14]
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