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Neurosurg Focus. 2015 Dec;39(6):E5. doi: 10.3171/2015.9.FOCUS15376.

Neurosurgery value and quality in the context of the Affordable Care Act: a policy perspective.

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Department of Neurosurgery, Louisiana State University of Health Sciences, Shreveport, Louisiana;
Harvard University John F. Kennedy School of Government, Cambridge, Massachusetts; and.
Carolina Neurosurgery & Spine Associates and Neuroscience Institute, Carolinas Healthcare System, Charlotte, North Carolina.


Neurosurgeons provide direct individualized care to patients. However, the majority of regulations affecting the relative value of patient-related care are drafted by policy experts whose focus is typically system- and population-based. A central, prospectively gathered, national outcomes-related database serves as neurosurgery's best opportunity to bring patient-centered outcomes to the policy arena. In this study the authors analyze the impact of the Affordable Care Act (ACA) on the determination of quality and value in neurosurgery care through the scope, language, and terminology of policy experts. The methods by which the ACA came into law and the subsequent quality implications this legislation has for neurosurgery will be discussed. The necessity of neurosurgical patient-oriented clinical registries will be discussed in the context of imminent and dramatic reforms related to medical cost containment. In the policy debate moving forward, the strength of neurosurgery's argument will rest on data, unity, and proactiveness. The National Neurosurgery Quality and Outcomes Database (N(2)QOD) allows neurosurgeons to generate objective data on specialty-specific value and quality determinations; it allows neurosurgeons to bring the patient-physician interaction to the policy debate.


AANS = American Association of Neurological Surgeons; ACA = Affordable Care Act; AMA = American Medical Association; Affordable Care Act; CMS = Center for Medicare and Medicaid Services; Medicaid; N2QOD = National Neurosurgery Quality and Outcomes Database; National Neurosurgery Quality and Outcomes Database; PQRS = Physician Quality Reporting System; PhRMA = Pharmaceutical Research and Manufacturers of America; QCDR = qualified clinical data registry; health care economics; health care reform; outcomes research

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