http://journals.lww.com/neurotodayonline/Fulltext/2016/01210/Neurologist_Care_Is_More_Expensive_But_Delivers.7.aspx
An analysis funded by the AAN found that while care
for chronic conditions by neurologists costs more than care by other
physicians, outcomes tend to be better.
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Care by a neurologist for chronic conditions may cost
more up front, but it can help reduce emergency department visits,
hospitalizations, and medical problems such as infections and fractures,
according to an analysis of a large insurance claims database published
in the December 23 online edition of Neurology.
The study also found that patients seen by neurologists
for chronic neurologic diseases such as multiple sclerosis (MS),
Parkinson's disease (PD), or epilepsy are more likely to get
disease-modifying treatments than patients who don't see neurologists.
The new study, funded by the AAN, comes amid growing
pressure on physicians and other health care providers to demonstrate
that their services provide value from both a monetary and outcomes
standpoint.
“When we [neurologists] are involved with care, the
costs of that care are a little bit more, but at the same time the
outcomes are substantially better and the quality of care is better,”(But what about results?)
said John P. Ney, MD, MPH, the study's lead author and staff neurologist
at the Edith Nourse Rogers Memorial Veterans Hospital in Bedford, MA.
The study is part of an ongoing AAN effort to quantify
the value of neurologist care. “Aggregation of health care information
in large administrative claims databases presents an opportunity to
assess the effect of specialist physicians on downstream usage of health
resources related to the disease they treat,” the researchers wrote.
“Payers, from the US Government to [third-party] private insurers and
employers, are looking to this kind of big data analysis to inform
coverage decisions, regulatory actions, and policymaking decisions.”
BETTER LONG-TERM OUTCOMES
The results may have looked like an argument against
neurology if the investigators had only analyzed attributable direct
health care expenditures for neurologic conditions, said Dr. Ney. But a
different story emerged when the researchers considered factors such as
adverse events, hospitalizations, and emergency department visits.
“Neurologist ambulatory care is associated with
decreased adverse events and usage of acute and post-acute health care
resources,” they concluded. In addition, all-cause hospitalizations were
less common for patients seen by a neurologist, which “suggests
neurologist visits may have beneficial effects even outside of the
treated neurological disorder.”
When neurologists were involved in care, for example, MS
patients had fewer urinary tract infections and decubitis ulcers; MS
and PD patients experienced fewer pneumonias and less major depression;
and PD patients used less home health agency care.The researchers did
not attach dollar amounts to the differences in utilization of acute and
post-acute care, but they plan to do so in future research, Dr. Ney
said.
The study also focused on the use of disease-specific
treatments and screenings. For most of the conditions, neurologists
seemed to improve care through the use of therapies considered to be
optimal treatments. For example, MS patients were more likely to be
given immunotherapy; stroke patients with atrial fibrillation were more
likely to be given anticoagulants; epilepsy patients were more likely to
get deep brain stimulation; and those with Parkinson's were more likely
to get dopaminergic therapies.
Having a neurologist involved made no obvious difference
in some cases. For instance, “yearly ophthalmologic screening and liver
function and blood count testing in MS (if using immune therapies),
physical and occupational therapy for PD, and medication compliance
rates in epilepsy and MS were not substantially different or slightly
worse in the group with identified neurologist care,” the study found.
The researchers said it was not surprising that costs
were higher with neurologist care, noting that the goal of health care
is “not to provide care at zero or net negative expenditure, but rather
to improve health and quality of life at acceptable costs.”
The study did have limitations. The authors noted that
it could not adequately adjust for differences in the severity of
patients' conditions, and absent information on all acute care
expenditures (including those outside the episode treatment groups), it
was impossible to say how much money may have been saved. Also, while it
makes sense that seeing a neurologist and using disease-specific
therapies would lead to higher quality of care and better outcomes, the
study was not designed to prove that hypothesis.
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