Overcoming The Cost Crunch in Neurology

By Hilliard Slavick, M.D.

When I began my practice 30 years ago, many community hospitals operated like “gentleman’s clubs” in which one doctor or one group controlled all neurology services, including consults, EEG readings, and EMG performance.

Due to the lack of competition, one only needed the loyalty and support of the hospital administration and several key primary care physicians.

By the mid-1980s, that began to change. HMOs developed and contracted with neurology groups, who had exclusive rights to serve their outpatient clinics and inpatient admissions. I signed a contract at Michael Reese HMO after it became clear that a significant portion of my private patients would be quickly lost. After initially handling only EMG performance, we have expanded and currently service four outpatient clinics.

But the business side of neurology has not gotten any easier during the past 20 years ago.

We must take into account contract negotiations with fellow physicians, staff hospitals, and insurance companies. We incur expenses from support personnel such as attorneys, CPAs and other consultants. And new hires expect a great deal in terms of salary and benefits, before they have extensively demonstrated their skill or ability to generate revenue for the practice.

Increased medical malpractice rates due to our lawsuit-happy culture have cut into our profit margins, as have decreased payments each month from insurers. A planned 10 percent Medicare cut, set to take effect on Jan. 1, 2008, threatens to further cut our profits.

Further squeezing the cost crunch, most private insurers base their payments off the Medicare figures. And insurers’ bias toward paying for surgeries, as opposed to the hands-on cognitive assessment care we provide, does not help matters.

In the face of these converging factors, Clinical Neurosciences continues to thrive. I like to think we work harder than most people. I put in the hours, I lecture, I ran a board review course for five years. I’ve trained a lot of doctors over the years. I’m constantly teaching.

That’s the way to do it. You’re available to people. You just have to work hard and develop the mindset that taking calls at times that might be inconvenient is part of the process. When your primary focus is taking care of your patients, then those calls are not an intrusion, but a reaffirmation of your personalized approach.

We also see patients more quickly than university hospitals, which often have waitlists of three and four years, and I don’t have a different resident seeing them on each visit, which can be frustrating to people. We essentially have a family practice in neurology. If a patient is not improving after two, three or four visits, I refer them to people I think can handle their case.

Over the years, I’ve cultivated a number of specialists to whom I feel confident sending patients. They, in turn, refer patients to me.

At the end of the day, amid all the big-picture changes I’ve described, overcoming the cost crunch in neurology is not merely about making a series of good business decisions. It’s about embracing what you do, accepting the role you play, and managing that decision not only in your practice but also in the greater community that you serve.