Authors: Sasha Vaziri, MD; Omar Awan, BS; Kyle Scott, BS; Saptarshi Chakraborty, PhD; Kshitij Khare, PhD; Maryam Rahman, MD, MS (Gainesville, FL)


In response to rising national health expenditures the patient protection and affordable care act (ACA) was passed in 2010, with major provisions implemented in 2014. The American Academy of Neurological Surgeons and Congress of Neurological Surgeons stated that the ACA vastly expands the federal governments role and fails to address the shortcomings of the healthcare system. In this study we evaluate trends in neurosurgical reimbursement, productivity and compensation before and after the implementation of the major provisions of the ACA.


Results from Neurosurgery Executives’ Resource Value and Education Society (NERVES) surveys were collected, representing data from 2011-2016. Based on the responses from different practice settings across the six years categorized into Before/After 2014, we performed inverse variance-weighted averaging within the frameworks of (a) a one-way ANOVA model with practice setting (Private/Hospital/Academic) as the sub-group factor and (b) a two-way ANOVA model with practice setting and Year (Before/After 2014) as the two sub-group factors. Within these frameworks, we used F-tests to detect any significant difference. 


The NERVES survey was distributed to neurosurgery practices in the United States. Response rate ranged from 19.6% to 36%. While medians values during a period of average annual GDP-growth of 2.05% for compensation, productivity and reimbursement were lower after the majority of the regulatory changes associated with the ACA were implemented (January 1,2014) no statistically significant differences were noted within practice type for neurosurgeons in academic, private-practice or hospital-employed groups for annual compensation, annual collections, gross charges, number of annual surgeries performed, total and work RVUs


Though the ACA has led to significant changes in healthcare, survey data suggests that no statistically significant differences in reimbursement, compensation and productivity have occurred for academic, private-practice, or hospital-employed neurosurgeons since implementation of the major provisions of the ACA.