I attended the second annual Neurohospitalist Society meeting in Denver last weekend. It was an excellent meeting for a few reasons. One is that there were only ~ 50 people there. Compared to the five or ten thousand that attend the AAN or stroke conferences, this was a totally different experience. The talks were kind of like a series of grand rounds, with ample time for questions and discussion. There was a gathering at a local brew pub Friday night, providing an opportunity to meet almost all of the attendees.
There were good clinical updates on falls, delirium, autoimmune encephalitis, and a great neurovirology talk by Dr. Kenneth Tyler.
There were also talks on the larger systemic issues affecting neurohospitalist practice, such as, “what is a neurohospitalist anyway?” Various training options were explored (stroke vs. critical care vs. neurophysiology fellowships vs. no fellowship). Setting up a practice and call schedule, teleneurology, health care reform and financing, and hospital administration were all addressed.
I’m going to expand on an interesting tidbit, since residents aren’t taught much about the business side of neurology: One of the presenters mentioned that he had done a detailed analysis of the hospital charges associated with hospitalized neurology vs. neurosurgery patients at his academic hospital. Shockingly, the neurology patients generated more downstream revenue (from MRIs, CEAs, etc.) than the neurosurgery patients, and it wasn’t even close. The explanation for this may have had to do with DRG and other bundled payment schemes applied to the surgical patients. Unfortunately, the data aren’t publishable since they are proprietary to the hospital.
The implication of this is potentially important to a neurohospitalist negotiating with a hospital’s administration. The party line, if you will, is that when a hospital employs a neurologist, the physician’s salary is a red-colored (i.e., negative) line item and his professional billings aren’t high enough to offset that. The hospital takes a loss on the neurologist’s salary in order to ensure that it can offer timely neurological care to the hospitalized patients, maintain a certified stroke center, maintain lucrative neurosurgical programs, etc. I coined (I think) a term for this–budgetary gerrymandering. The neurologist’s costs are included in the budget, but the value he generates beyond his professional billing (which is admittedly more challenging to tally than his RVUs) are excluded. This makes the neurologist look like a loser and puts him at a negotiating disadvantage.
Knowing that the value you bring to the organization extends beyond your RVUs might be helpful in discussions with your hospital’s administration, whether these are over salary or other matters such as the need to hire additional docs or mid-levels, purchase new equipment, etc. Understand, however, that you can’t just demand to be paid a portion of the hospital’s revenue stemming from your work–that could be construed as a kickback, which is illegal.
Another thing to keep in mind (but I don’t recommend saying it in so many words–I call it the nuclear counter-argument) is that non-physician administrators don’t generate any RVUs. Of course, every large organization needs executives, accountants, lawyers, etc., but in health care their ranks (and salaries) are growing:
Anyway, it was a really good meeting and I encourage anyone interested in hospitalist neurology to get involved.