As 2014 comes to a close, I’m starting to look ahead to 2015 and plan topics that I’d like to cover on this blog. One such topic, which I think will cause quite a stir, has to do with quality. In my opinion, the field of neuromonitoring has been watered-down, pulverized to the point where it is hardly recognizable compared to what it once was. Whereas neuromonitoring was once provided on a one-to-one patient-to-neurophysiologist basis, with top-tier neurophysiologists performing neuromonitoring in the operative suite, today the landscape is much different.
Most companies out there seem to provide a service that they don’t even understand. They don’t even know where to begin with educating their employees about neuromonitoring, and yet they seem content to provide the service, as long as their “techs” can connect to an online neurologist and receive instructions from internet chat rooms. Neurologists, many of whom have little or no actual training in neuromonitoring, hang out in the chat rooms “supervising and interpreting” data for many patients simultaneously, often from hundreds or thousands of miles away. Surgeons are so used to “bad” neuromonitoring these days, that many tend to place little value on the data.
Despite these shortcomings, the demand for neuromonitoring is really quite high; however, perhaps because of these shortcomings, insurance companies are refusing to reimburse for neuromonitoring and hospitals want the service for next to nothing. This actually seems to feed the cycle as lower reimbursements force companies to find the cheapest possible way to provide a neuromonitoring service. In this scenario, we really can’t afford to have the best neurophysiologists take care of patients, and certainly not in a one-to-one model. Everyone would go bankrupt. Interestingly, as prices for neuromonitoring services have recently bottomed-out, hospitals are starting to talk about quality again. They want the highest quality at the lowest price. Who doesn’t, right?
So, as I start to think about my future posts on the blog, I am certain that quality is a topic that must be covered.
I want your help, though. Think about this question:
What constitutes quality in neuromonitoring?
From the perspective of a company, hospital, patient, surgeon, neurophysiologist,.. What constitutes quality neuromonitoring? Tell me your thoughts. Leave a comment below.
Me? I think I know the answers, meaning that I know good neurophysiology when I see it. So, I feel that I could answer the question from the perspective of a hospital, surgeon, anesthesiologist, patient and neurophysiologist. I want to hear your thoughts, though. Tell me what you think.
Cheers and happy holidays!