AAN Position: On-Call Reimbursement for Neurologists
Neurologists are critical in evaluating and caring for patients with emergent neurologic illness, including stroke, but it has become increasingly difficult to find enough neurologists to meet the need. The current demand for neurologists exceeds the supply.
Increased malpractice liability, increased office overhead, and inadequate reimbursement for emergency services have combined to make it financially difficult for neurologists to care for people with emergent illness. The imbalance in the American medical system forces neurologists to choose to limit or abandon emergency coverage in favor of other, essential and underserved professional services in their communities. Hospitals benefit from emergency department services which support their diagnostic and other ancillary facilities. Emergency department and emergent inpatient coverage represents a disproportionate time commitment and financial demand on community neurologists because it is a service to hospitals which goes beyond service to the community, and it should be recognized and reimbursed separately from payment for normal patient care.
In order to allow for increased access to patients, and referring hospital physicians to neurologic care, telemedicine has been employed as an increasingly popular way to provide emergency coverage, especially in areas with few to no neurologists. Telemedicine allows for an efficient way for a neurologist to provide inpatient coverage from a distance without a need to travel between sites, allowing for greater geographical coverage, but still represents a large time commitment for the neurologist during which other community obligations will need to be put on hold.
The aan position
The American Academy of Neurology (AAN) believes that patients and communities will have better access to high-quality emergency neurologic care for stroke and other illnesses when neurologists are reimbursed at fair market value to provide on-call services including telemedicine. For affiliated neurologists, payments for on-call services should be reimbursed at fair market value. For employed neurologists, these payments should be factored in as an additional amount to their total annual compensation.
Using benchmarking data can help determine fair market value for emergent on-call services. Benchmarking data can be found from a variety of resources, including the AAN’s Neurology Compensation and Productivity survey. In using benchmarking data, neurologists must make independent economic decisions based on their individual circumstances.
Policy Statement History
Reviewed and approved by the Medical Economics and Management Committee on October 4, 2012; approved by the AAN Board of Directors on June 28, 2013. Updated by the Medical Economics and Management Committee in 2018 and approved by the AAN and AANI Boards of Directors February 6, 2019.