Introduction: The Massachusetts Healthcare Policy of 2006 has many similarities to the Affordable Care Act (ACA). There are concerns the ACA will negatively impact case volume and reimbursement for physicians. Analyzing neurosurgical cases and patient insurance status before and after the Massachusetts policy change can provide insight into the future of neurosurgery in the American healthcare system.

Methods: The Massachusetts State Inpatient Database, which provides demographic information on hospital discharges, was studied for all neurosurgical ICD-9 procedure codes from 2001 to 2012. Four categories of ICD-9 codes were created: Tumor, Other Cranial/Vascular, Shunts and Spine. A comparison of case totals and uninsured cases, before and after the policy change, was performed. Data from New York were used as a control.

Results: After 2008, there was a decrease in uninsured cases in all four categories in Massachusetts. The number of cases for Tumor and Spine were unchanged, while Other Cranial/Vascular increased. Shunt totals decreased post-policy, but exhibited a similar trend to the control. For New York, Spine case total and uninsured case volume increased, while Other Cranial/Vascular case totals decreased.

Conclusions: After the Massachusetts Healthcare Reform, the number of uninsured individuals undergoing surgeries significantly decreased for all categories of neurosurgical procedures, but more importantly, the total number of cases did not change dramatically. To the extent that Massachusetts predicts the overall U.S. experience, some aspects of reimbursement may be positively impacted by the ACA. Neurosurgery, which treats patients with more urgent conditions, may be affected differently than other specialties.

Patient Care: The American healthcare system is undergoing significant change with the implementation of The Affordable Care Act. It is unclear how neurosurgery will be impacted by this policy change. Massachusetts offers the opportunity to gain insight into how patient insurance status as well as reimbursements may change in a healthcare environment which requires insurance for all individuals.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) Understand uninsured cases for all categories of neurosurgery declined in Massachusetts post-policy. 2) Recognize the total number of neurosurgical cases did not increase for the majority of procedure categories post-reform. 3) Discuss the potential impact of patient insurance status and case volume changes on reimbursements for neurosurgeons in a healthcare model which requires insurance for all individuals.

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