The Continuum of Neurosurgical Care: Increasing the Neurosurgeon's Role and Responsibility

The Health Care Reform Act has fostered a shift toward capitation and shared risk among providers to improve quality and reduce the escalating costs of healthcare. Like all physicians, neurosurgeons are increasingly being incentivized to participate in efforts to streamline care through the use of surgical pathways to reduce hospital length of stay and prevent readmissions. These changes have expanded the role of the neurosurgeon along the continuum of care for the neurosurgery patient. This paper predicts and advocates for a further broadening of neurosurgery participation from programs that reward physicians for helping to prevent a high-risk patient's need for surgery to management of postacute rehabilitation. It also introduces the concept of risk reduction more generally at the community level through collaborative interventions that improve health through changes to the built environment, innovations in transportation, and improved access to healthy food and recreation opportunities.