481 The Value of a Neurosurgeon: Is Neurosurgical Compensation Proportional to Value Added?

INTRODUCTION: Determining the value of a neurosurgeon is complex and, as healthcare reimbursement transitions towards value-based/bundled payments, such determinations have become increasingly difficult and confusing. METHODS: A neurosurgical value model for hospitals was created using Medicare reimbursement methods to estimate the financial contribution of a single neurosurgeon to a hospital system. Furthermore, 5,380 organizations 990 IRS tax filings were examined for comparative trends in profits and revenue on a hospital-wide basis. RESULTS: Mean and median annualized excess hospitalization revenue from a neurosurgeon over the same number of equal medical admissions was $5,120,533 and $5,141,160, respectively. For private practice groups who capitalize all work relative value units (wRVU) based Medicare part B payments, the annualized mean and median yearly hospital revenue over a comparable medical admission was calculated to be $1,539,703 and $1,902,555, respectively. For hospital-employed neurosurgeons, the respective addition of Medicare part B payments increased the mean and median values to $2,249,552 and $2,612,403, respectively. Analysis of non-profit IRS Form 990s revealed a substantial rise in executive compensation since 2011, with a mean increase of 709% and a median increase of 11%. During the same period, hospital revenue experienced a mean increase of 199% and a median increase of 24%. Both executive compensation and revenue distributions were largely positively skewed. Neurosurgeon median earnings over a similar period, reported through surveys, exhibited varied increase, however significant reporting variation exists. CONCLUSIONS: Value created as a neurosurgeon is complex but is a key driver of hospital revenue, with up to $2.6 million created annually from neurosurgical admissions. Further discussion is needed to elucidate alternative innovative payment strategies to ensure physicians remain active in an evolving healthcare system.