Downstream Revenue Generated After Visits to Neurologists: A Claims-Based Analysis of Medicare Data

To determine downstream revenue of neurologists compared with nonneurologists after incident diagnostic visits by analysis of Medicare claims.

Using 20% randomly selected and nationally representative sample of claims from Medicare insured patients between 2015 and 2019, we identified patients with multiple sclerosis (MS), Parkinson disease (PD), epilepsy or other seizures, dementia, and autoimmune neuromuscular diseases who had a new or follow-up evaluation and management (E/M) encounter for care with a neurologist (cases) in the outpatient, inpatient, or emergency settings. Using 1:1 propensity score matching with variables including demographics, comorbidities, and indicators of social determinants of health to identify index encounters for the same diagnoses with nonneurologists (controls), we compared generation of downstream revenues from services including E/M visits, infusion, procedures, durable medical equipment, and inpatient care up to 1 year after the index visit including medication.

Total revenues were higher in cases than controls for all groups including autoimmune neuromuscular diseases (+519%, $58,694,251 vs $9,482,866), followed by epilepsy or other seizures (+152%, $297,126,099 vs $117,962,482), MS (+77%, $31,820,922 vs $17,991,539), dementia (+30%, $100,152,203 vs $76,934,093), and PD (+30%, $64,619,112 vs $49,694,105) Reimbursement per patient was the largest for autoimmune neuromuscular conditions (cases mean: $18,722, SD: $44,085; controls mean: $3,025, SD $17,642), followed by MS (cases mean: $9,496, SD: $22,490; controls mean $5,369, SD $15,993), epilepsy or other seizures (cases mean: $8,388, SD: $22,183; controls mean $3,330, SD $13,249), PD (cases mean: $8,193, SD: $19,867; controls mean $6,301, SD $17,341), and dementia (cases mean: $2,209, SD: $8,655; controls mean $1,697, SD $7,715). Inpatient admissions generated the most downstream revenue, followed by procedures in PD, epilepsy or other seizures, and dementia and medication infusions in MS and autoimmune neuromuscular disease. Neurologist attributable reimbursement was minimal compared with reimbursement for other specialties when accounting for all revenues.

Compared with nonneurologists, neurologists guide diagnostic evaluation and treatment generating significantly greater downstream revenue after the incident diagnosis of 5 neurologic disorders including MS, PD, epilepsy or other seizures, dementia, and autoimmune neuromuscular conditions. These findings underscore the clinical and financial worth of neurologists to health systems providing specialty and subspecialty care for neurologic disorders.