Publications

Using nationally representative data from NAMCS, we demonstrate that the most expensive tests and procedures ordered by neurologists are MRIs, EMGs, and EEGs. In fact, our country spends more money each year on MRIs ordered by neurologists than on all visits to a neurologists combined. This work sets the stage for future work to better understand and improve inefficiencies in neurologic healthcare.

Burke JF, Skolarus LE, Callaghan BC, Kerber KA: Choosing Wisely: Highest-cost tests in outpatient neurology Ann. Neurol. 73(5): 679-683, 2013. PM23595536

Using nationally representative data from NAMCS, we report that headache neuroimaging is common, costly, increasing over time, and is often guideline discordant. Our country spends nearly $1billion each year in headache neuroimaging despite multiple guidelines that recommend against these tests particularly in those with migraines or chronic headaches. This work has led to an ongoing grant with the goal to optimize headache neuroimaging in Veterans. 

Callaghan BC, Kerber KA, Pace RJ, Skolarus LE, Burke JF: Headaches and neuroimaging: High utilization and costs despite guidelines JAMA Intern Med 174(5): 819-821, 2014. PM24638246/PM:24638246

Using publicly available Medicare Part B data, we demonstrated that the Medicare reimbursement reduction for NCS resulted in fewer providers performing these studies particularly providers other than neurologists and physiatrists. Medicare saved approximately $200 million dollars. EMG tests, which should often be performed with NCS, did not decrease substantially. This work highlights the effects that Medicare reimbursement can have on utilization of services.

Callaghan BC, Burke JF, Skolarus LE, Jacobson RD, De Lott LB, Kerber KA: Medicare's Reimbursement Reduction for Nerve Conduction Studies: Effect on Use and Payments. JAMA Intern Med 176(5): 697-699, 2016. PM27018752

Using publicly available Medicare Part D data, we reported the most expensive medications prescribed by neurologists. Most of the top 10 medications were multiple sclerosis medications. Medicare spends almost as much on glatiramer acetate each year as it does on all visits to neurologists. Negotiating at VA rates would save the country billions of dollars each year in medication costs. This work highlights the high costs of neurologic drugs and the need for interventions to reign in these costs. 

De Lott LB, Burke JF, Kerber KA, Skolarus LE, Callaghan BC: Medicare Part D payments for neurologist prescribed drugs. Neurology 86(16): 1491-8, 2016. PM27009256

Using publicly Optum data, we demonstrate that out-of-pocket costs are on the rise for commonly prescribed neurologic medications. The rise is particularly severe for those in high deductible health care plans. Since multiple sclerosis medications have the highest overall costs, they also have the highest out-of-pocket costs. In contrast to several years ago, out-of-pocket costs are now high enough that all neurologists need a working knowledge of these costs and the ability to discuss them with their patients.

Out-of-pocket costs are on the rise for commonly prescribed neurologic medications. Callaghan BC, Reynolds E, Banerjee M, Kerber KA, Skolarus LE, Magliocco B, Esper GJ, Burke JF.Neurology. 2019 May 28;92(22):e2604-e2613. doi: 10.1212/WNL.0000000000007564. Epub 2019 May 1.

We evaluated a strategy to increase use of the test (Dix-Hallpike’s test [DHT]) and treatment (canalith repositioning maneuver [CRM]) for benign paroxysmal positional vertigo in the emergency department. We found that the use of the DHT or CRM in the estimated target population increased from 7% in control visits to 17% in intervention visits. Head CT use was lower in intervention visits compared with control visits (44.0% versus 36.9%). No differences were observed in 90-day subsequent stroke risk. Providers who used the materials typically reported positive clinical experiences but engagement was low at nonacademic facilities.

Kerber KA, Damschroder L, McLaughlin T, Brown DL, Burke JF, Telian SA, Tsodikov A, Fagerlin A, An LC, Morgenstern LB, Forman J, Vijan S, Rowell B, Meurer WJ. Implementation of Evidence-Based Practice for Benign Paroxysmal Positional Vertigo in the Emergency Department: A Stepped-Wedge Randomized Trial. Annals of Emergency Medicine. 2019 [In Press]. PMID: 31866170.