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Neurocritical Care

, Volume 30, Issue 1, pp 177–184 | Cite as

Specialty Classifications of Physicians Who Provide Neurocritical Care in the United States

  • Andrew Martin
  • Monica L. Chen
  • Abhinaba Chatterjee
  • Alexander E. Merkler
  • Caroline D. Chung
  • Xian Wu
  • Nicholas A. Morris
  • Hooman KamelEmail author
Original Article

Abstract

Background

We sought to characterize the specialty classification of US physicians who provide critical care for neurological/neurosurgical disease.

Methods

Using inpatient claims between 2009 and 2015 from a nationally representative 5% sample of Medicare beneficiaries, we selected hospitalizations for neurological/neurosurgical diseases with potential to result in life-threatening manifestations requiring critical care. Using Current Procedural Terminology® codes, we determined the medical specialty of providers submitting critical care claims, and, using National Provider Identifier numbers, we merged in data from the United Council for Neurologic Subspecialties (UCNS) to determine whether the provider was a UCNS diplomate in neurocritical care. We defined providers with a clinical neuroscience background as neurologists, neurosurgeons, and/or UCNS diplomates in neurocritical care. We defined neurocritical care service as a critical care claim with a qualifying neurological/neurosurgical diagnosis in patients with a relevant primary hospital discharge diagnosis and ≥ 3 total critical care claims, excluding claims from the first day of hospitalization since these were mostly emergency-department claims. Our findings were reported using descriptive statistics with exact confidence intervals (CI).

Results

Among 1,952,305 Medicare beneficiaries, we identified 99,937 hospitalizations with at least one claim for neurocritical care. In our primary analysis, neurologists accounted for 28.0% (95% CI, 27.5–28.5%) of claims, neurosurgeons for 3.7% (95% CI, 3.5–3.9%), UCNS-certified neurointensivists for 25.8% (95% CI, 25.3–26.3%), and providers with any clinical neuroscience background for 42.8% (95% CI, 42.2–43.3%). The likelihood of management by physicians with a clinical neuroscience background increased proportionally with patients’ county-level socioeconomic status and such providers were 3 times more likely to be based at an academic medical center than other physicians who billed for critical care in our sample (odds ratio, 2.9; 95% CI, 1.1–8.1).

Conclusions

Physicians with a dedicated clinical neuroscience background accounted for less than half of neurocritical care service in US Medicare beneficiaries.

Keywords

Neurocritical care Physician specialty Staffing model Care delivery Unit organization 

Notes

Authors’ Contributions

AM made substantial contributions to the conception and design of the work, acquired, analyzed, and interpreted data for the work, drafted and revised the manuscript for intellectual content, and provided final approval of the version to be submitted. MLC analyzed and interpreted data for the work, revised the manuscript for intellectual content, and provided final approval of the version to be submitted. AC acquired, analyzed, and interpreted data for the work, drafted and revised the manuscript for intellectual content, and provided final approval of the version to be submitted. AEM made contributions to the conception and design of the work, revised the manuscript for intellectual content, and provided final approval of the version to be submitted. CDC interpreted data for the work, revised the manuscript for intellectual content, and provided final approval of the version to be submitted. XW interpreted data for the work, revised the manuscript for intellectual content, and provided final approval of the version to be submitted. NAM made contributions to the conception and design of the work, interpreted data for the work, revised the manuscript for intellectual content, and provided final approval of the version to be submitted. Hooman Kamel made contributions to the conception and design of the work, acquired and analyzed the data, revised the work critically for intellectual content, provided study supervision, and provided final approval of the version to be submitted.

Source of support

Alexander E. Merkler is supported by NIH Grant KL2TR0002385 and the Leon Levy Foundation in Neuroscience. Hooman Kamel is supported by NIH Grants K23NS082367, R01NS097443, and U01NS095869 as well as by the Michael Goldberg Research Fund.

Compliance with ethical standards

Conflicts of interest

None of the authors have a conflict of interest.

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2018

Authors and Affiliations

  1. 1.Clinical and Translational Neuroscience UnitFeil Family Brain and Mind Research Institute, Weill Cornell Medical CollegeNew YorkUSA
  2. 2.Division of Stroke and Neurocritical Care, Department of NeurologyWeill Cornell Medical CollegeNew YorkUSA
  3. 3.Department of Healthcare Policy and ResearchWeill Cornell Medical CollegeNew YorkUSA
  4. 4.Department of NeurologyColumbia College of Physicians and SurgeonsNew YorkUSA
  5. 5.Department of NeurologyUniversity of Maryland School of MedicineBaltimoreUSA

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