Vol. 100, August 2024 DC E-Newsletter
Special Announcements
Charlotte Pineda Named CNS/AANS Vice President of Health Policy and Advocacy
On July 1, the Congress of Neurological Surgeons (CNS) and the American Association of Neurological Surgeons (AANS) issued a press release announcing the appointment of Charlotte Pineda as CNS/AANS VP of health policy and advocacy. Following the press release, The Hill, Politico and Becker’s Spine announced Ms. Pineda’s new position. Ms. Pineda previously worked as health policy director for Sen. Roger Marshall, MD, (R-Kan.) and is succeeding Katie O. Orrico, JD, in her new role. With a track record of bipartisan collaboration, Ms. Pineda has helped advance legislation critical to neurosurgery, including streamlining prior authorization, improving the Medicare physician payment system, expanding value-based care, medical liability reform, promoting health care competition and increasing the physician workforce.
“The AANS and CNS have been at the forefront in advancing legislative and regulatory policies not only for neurosurgeons but also alongside their partners and coalitions across the health care stakeholder community,” said Ms. Pineda. “Medicine is at a unique crossroads at this point in time, facing myriad challenges. I am incredibly honored to lead this talented team in developing and advancing durable policy solutions that help improve patient care.”
Legislative Affairs
Prior Authorization Reform Legislation Introduced in Congress
On June 12, Sens. Roger Marshall, MD, (R-KS); Kyrsten Sinema (I-AZ); John Thune (R-SD) and Sherrod Brown (D-OH) and Reps. Mike Kelly (R-Pa.), Suzan DelBene (D-WA), Ami Bera, MD, (D-CA), and Larry Bucshon, MD, (R-IN) introduced the Improving Seniors’ Timely Access to Care Act (S.4532/H.R. 8702). This legislation would codify and enhance elements of the Advancing Interoperability and Improving Prior Authorization processes rule that was finalized by the Centers for Medicare & Medicaid Services (CMS) earlier this year. Specifically, the legislation would:
- Establish an electronic prior authorization (e-PA) process for Medicare Advantage (MA) plans;
- Increase transparency around MA prior authorization requirements and their use;
- Provide a pathway for CMS to institute real-time decisions for routinely approved medical services;
- Clarify CMS’ authority to establish timeframes for e-PA requests; and
- Require several reports to Congress on program integrity efforts and other ways to improve the e-PA process.
In announcing the introduction of the legislation, Sen. Marshall issued a press release featuring the Regulatory Relief Coalition’s (RRC) support. The CNS and the AANS issued a press release lauding the legislation. Subsequently, Becker’s Spine Review published an article quoting Russell R. Lonser, MD, chair of the department of neurosurgery at The Ohio State University and chair of the CNS/AANS Washington Committee. Policy & Medicine also published an article on the topic, quoting Dr. Lonser, “The widespread overuse of prior authorization, especially in Medicare Advantage, has led to unacceptable delays and denials of essential medical treatments. We are optimistic that this will be the year Congress acts to safeguard timely care for our seniors.”
The legislation is supported by nearly 450 national and state organizations representing patients, physicians, MA plans, hospitals, and other key stakeholders in the health care industry. Support continues to grow.
Senate Introduces Medicare Physician Fee Schedule Fix Legislation
On August 1, Sens. John Boozman (R-AR), Peter Welch (D-VT), Thom Tillis (R-NC), Angus King (I-ME), Roger Marshall, MD (R-KS), and Jeanne Shaheen (D-NH) introduced the bipartisan Physician Fee Stabilization Act (S. 4935) to reform the outdated Medicare physician fee schedule. The bill addresses issues that have led to significant payment cuts, particularly in rural areas, and ensures fair compensation for health care providers. The bill has garnered strong support from medical organizations, including the CNS and the AANS.
Click here to read Sen. Boozman’s press release, highlighting the CNS and the AANS' support of the legislation.
Physician-Owned Hospital Repeal Gains More Bipartisan Support
On July 11, Reps. Michael C. Burgess, MD (R-TX), Tony Cárdenas (D-CA), Morgan Griffith (R-VA), and Vicente Gonzalez (D-TX) introduced the bipartisan Physician Led and Rural Access to Quality Care Act (H.R. 9001) to increase access to care in rural areas by establishing exceptions to rules for physician-owned hospitals in rural areas. The bill removes a ban that prevents existing physician-owned hospitals from expanding. The AANS and CNS are members of an informal coalition led by Physician-Led Hospitals of America and are advocating to gain more bipartisan support of the narrowed scope bill. The AANS and CNS are supportive of the full repeal bill, Patient Access to Higher Quality Health Care Act (S.470 / H.R. 977).
Click here to read Rep. Burgess’ press release.
House Appropriators Advance Health Spending Bill
On July 10, the House Appropriations Subcommittee approved its Labor, Health and Human Services, Education (L-HHS-E) Fiscal Year (FY) 2025 legislation. It includes $107 billion for HHS, which is $8.5 billion below the FY 2024 enacted level, including:
- National Institutes of Health (NIH), a total of $48 billion for NIH, level funding from FY 2024, including:
- Proposes the largest restructuring of the NIH, consolidating 27 centers into 15. This includes merging the National Institute of Neurological Disorders and Stroke (NINDS), National Institute of Dental and Craniofacial Research (NIDCR) and National Eye Institute (NEI) into the new National Institute on Neuroscience and Brain Research and providing $4.1 billion in funding.
- $7.8 billion for the National Cancer Institute (NCI)
- Defunded programs include:
- Advanced Research Projects Agency for Health (ARPA-H)
- Alzheimer’s Disease Program
- Administration for Strategic Preparedness and Response (ASPR) – The bill includes $3.6 billion for ASPR, a decrease of $4 million below the FY 2024 level and $137 million below the FY 2025 request.
- Increases by $3 million the Traumatic Brain Injury Program from FY 2024 to $16 million for FY 2025.
- Reduces funding for Centers for Disease Control and Prevention (CDC) by $1.8 billion to $7.4 billion.
Following the release of the L-HHS-E FY 2025 Appropriations bill, the CNS and the AANS sent a letter to Reps. Tom Cole (R-Okla.) and Rosa DeLauro (D-Conn.) urging Congress to increase NIH funding and express concerns with the NIH restructure proposal.
Click here to for the bill.
Neurosurgery Supports Gun Violence Prevention Research Funding
On June 3, the CNS, the AANS, the CNS/AANS Section on Neurotrauma & Critical Care and the CNS/AANS Section on Pediatric Neurological Surgery joined more than 430 organizations on a letter to the House and Senate Appropriations Committees urging the inclusion of increased funding for public health research into firearm morbidity and mortality prevention. Specifically, the letter requested $35 million for the CDC, $25 million for the NIH, and $1 million for the National Institute of Justice (NIJ) to conduct this crucial funding. Congress provided $12.5 million for the CDC and $12.5 million for NIH in FY 2024, and the letter hoped to encourage the Appropriations Committees to sustain and build on this funding for FY 2025. Unfortunately, the House Appropriations Committee did not provide any FY 2025 funding.
CNS and AANS Continue to Advocate for Medicare Payment Reforms
On May 17, Senate Finance Committee Chair Ron Wyden (D-Ore.) and Ranking Member Mike Crapo (R-Idaho) released the “Bolstering Chronic Care through Physician Payment: Current Challenges and Policy Options in Medicare Part B” white paper. On June 14, the CNS and the AANS joined the Alliance of Specialty Medicine in sending a comment letter with recommendations for stabilizing and improving Medicare physician reimbursement and performance programs through legislative reforms. The CNS and the AANS also join the Surgical Coalition in sending a comment letter expressing enthusiastic support for the committee’s efforts and offering principles for consideration.
Click here to read the Alliance of Specialty Medicine letter and here to read the Surgical Coalition letter.
Neurosurgery Supports Increased Funding for BRAIN Initiative in FY 2025
On June 17, the CNS and the AANS sent letters to both the House and Senate Appropriations Committees urging the members to provide a significant increase in FY 2025 funding for The Brain Research Through Advancing Innovative Neurotechnologies® (BRAIN) Initiative. The FY 2024 appropriations legislation slashed the funding for the BRAIN Initiative by 41 percent, from $680 million in FY 2023 to $402 million in FY 2024. This amount represents a massive blow to dedicated neurosurgeons.
While the House Appropriations Committee approved report acknowledges that the “BRAIN initiative is an ambitious program to develop and apply new tools and technologies to answer fundamental questions about the brain and ultimately to inspire new treatments for brain diseases,” it does not provide a specific FY 2025 funding amount within the proposed new National Institute on Neuroscience and Brain Research.
Neurosurgery Recommends GME Policy Options to Senate
Following the Bipartisan Medicare Graduate Medical Education (GME) Working Group’s draft policy proposal outline and questions for consideration, the CNS and the AANS joined the Alliance of Specialty Medicine and the Graduate Medical Education Advocacy Coalition (GMEAC) in sending letters to Sens. Ron Wyden (D-Ore.), John Cornyn (R-Texas), Robert Menendez (D-N.J.), Bill Cassidy, MD, (R-La.), Michael Bennet (D-Colo.), Thom Tillis (R-N.C.), Catherine Cortez Masto (D-Nev.) and Marsha Blackburn (R-Tenn.). The letters provide GME policy recommendations to address physician workforce shortages.
Click here to read the Alliance of Specialty Medicine letter and here to read the GMEAC letter.
Coding and Reimbursement
CNS and AANS Voice Concerns about Transforming Episode Accountability Model (TEAM)
On June 10, the CNS and the AANS commented on CMS’ newly proposed mandatory episode-based payment model, under which select acute care hospitals would be responsible for reducing Medicare spending while preserving or enhancing quality of care for Medicare beneficiaries undergoing certain surgical procedures, including spinal fusion, starting in 2026. Organized neurosurgery’s primary concern focused on the mandatory nature of the program and the failure of CMS to provide physicians with a role in the development and governance of the model. The CNS and the AANS also opposed CMS’ proposed use of broad quality metrics that have little relevance to spinal fusion patients; its use of a 30-day episode window, which impedes meaningful analyses of spinal fusion patients; and the use of inadequate risk adjustments to set target prices, which prioritize simplicity over accuracy. Finally, the CNS and the AANS cautioned against CMS’ rushed implementation timeline, which fails to account for a complete evaluation of predecessor payment models and for a concurrent CMS proposal to update spinal fusion MS-DRGs. CMS will consider the public’s feedback when determining whether and how to finalize this model.
Neurosurgery Urges CMS to Delay Implementation of Spinal Fusion MS-DRG Changes
On June 10, the CNS and the AANS provided comments on provisions in the FY 2025 Medicare Hospital Inpatient Prospective Payment System proposed rule. Specifically, neurosurgery notes that CMS has proposed to change the spinal fusion facility payment Medicare Severity-Diagnosis Related Groups (MS-DRGs) to better account for what CMS has concluded is the biggest driver of cost differentials: whether the case is single or multiple levels. The CNS and the AANS recommended that CMS delay implementation of this restructuring and provide more information about the potential impact of the changes and allow additional time for review.
MedPAC Releases June 2024 Report to Congress
On June 15, the Medicare Payment Advisory Commission (MedPAC) released its annual report to Congress. Each year, as part of its statutory mandate, MedPAC reports on issues affecting the Medicare program, as well as changes in the health care delivery system more broadly. A press release is available here. Matters of interest to neurosurgery in the report include:
- Acknowledgement of physician concerns about increasing practice costs and decreasing payment under the Medicare Physician Fee Schedule (MPFS). The report notes, “This gap between the growth in clinician input costs and updates to MPFS payment rates could, over time, create incentives for clinicians to reduce the number of Medicare beneficiaries they treat or stop participating in Medicare entirely.”
- Two options to update MPFS payment rates based on some measure of inflation. The first approach would update the practice expense portion of the fee schedule payment rates by the hospital market basket, adjusted for productivity. The second approach would update total fee schedule payment rates by the Medicare Economic Index (MEI) minus one percentage point.
- A recognition that limited provider networks and inappropriately applied prior authorization requirements in Medicare Advantage programs have led to denial and delays of necessary patient care and contributed to provider administrative burden.
- A discussion of payment for software technologies in Medicare, suggesting continued evaluation and adjustment of payment models to accommodate the rapid advancement of medical software technologies. This includes considering the implications of Artificial Intelligence (AI) and machine skill learning, where software not only supports but potentially replaces human decision-making in clinical settings.
CMS Ends Assistance for Cash Flow Disruptions
On June 17, CMS announced that as of July 12, it will discontinue the Change Healthcare/Optum Payment Disruption (CHOPD) program that helped support providers experiencing cash flow disruptions. CMS has issued more than $2.55 billion in accelerated payments to more than 4,200 Medicare Part A providers, and more than $717.18 million in accelerated payments to 4,722 Part B suppliers. More than 96% of the payments made through the program have already been recovered. CMS will no longer accept new applications for CHOPD and recommends that providers continuing to have difficulty billing or receiving payment contact Change Healthcare directly or contact their Medicare Administrative Contractor (MAC). CMS will monitor for other effects of the cyberattack and will continue to engage industry partners to address remaining concerns. CMS encourages all providers to review their cybersecurity risk. Some resources from the agency to that end may be found here.
CMS Releases 2025 Medicare Physician Fee Schedule Proposed Rule
On July 10, CMS released the calendar year (CY) 2025 Medicare Physician Fee Schedule (MPFS) proposed rule. CMS proposes a CY 2025 conversion factor of $32.3562, down approximately 2.8% from the CY 2024 conversion factor of $33.2875. This is due to the expiration of the 2024 2.93% bump provided by Congress, plus a positive budget neutrality adjustment of 0.05% triggered by CY 2025 policies. As part of the proposals, CMS is addressing its global surgical payment policy by emphasizing the use of transfer of care modifiers and requiring modifiers for follow-up care provided by a practitioner other than the operating surgeon. Overall, CMS estimates that the policy recommendations in the proposed rule will not have a significant financial impact on the specialty of neurosurgery.
For additional details, see:
Comments are due on Sept. 9. Washington Office staff will prepare a summary of the proposal to distribute to our members and will draft a response letter.
A few initial highlights of payment issues of interest to neurosurgeons are below:
- Global Surgical Modifiers. CMS is proposing to broaden the use of the transfer of care modifiers for global packages and require the use of the existing modifiers (-54, -55 and -56) for all 90-day global surgical packages in any case when a practitioner (or another practitioner from the same group practice) expects to furnish only a portion of a global package (including but not limited to when there is a formal, documented transfer of care as under current policy or an informal, non-documented but expected, transfer of care.) CMS also proposes a new E/M add-on code for use by practitioners who did not perform the procedure (i.e., did not bill the global code) but did provide post-procedure care.
- Updated Code Values for New/Revised Services. CMS did not accept the RUC-passed work relative value (RVW) of 18.95 for the new Cat. I code for MRI-guided focused ultrasound (MRgFUS) and have proposed a lower RVW of 16.60. The CNS and the AANS will object to this reduction in our comments, in comments from the RUC and other partners and a meeting with CMS.
- Practice Expense (PE). CMS acknowledges the ongoing American Medical Association Physician Practice Information Survey and has contracted with the RAND Corporation to develop other methods for measuring and updating PE.
- Quality Payment Program (QPP)
- CMS continues to expand upon the Merit-Based Incentive Payment System (MIPS) Value Pathway (MVP) framework by proposing new MVPs — including a problematic Surgical Care MVP that combines measures related to spine surgery, thoracic surgery and general surgery — and seeks feedback on potentially sunsetting traditional MIPS and fully transitioning to MVPs in 2029.
- CMS proposes to revise MIPS scoring methodologies to allow for more successful participation among clinicians reporting specific high-performing quality measures subject to a scoring cap and to enhance cost measure scores, which have traditionally been lower than quality measures scores.
- CMS proposes to maintain the 75-point MIPS performance threshold, which is the minimum number of points needed to avoid a penalty, recognizing the need for consistency and additional time for more recent data not impacted by the COVID-19 pandemic to become available.
- Qualifying Participants (QPs) in Advanced Alternative Payment Models (APMs) will continue to be exempt from MIPS. While QPs will receive a 1.88% APM incentive payment in 2026 (based on eligibility in 2024), QPs will no longer be eligible for an APM incentive payment starting next year. Per statute, starting in 2026, CMS will apply two separate PFS conversion factor updates — one for QPs (0.75%) and one for all non-QP eligible clinicians, including MIPS participants (0.25%). Also, beginning next year, the Medicare payment and patient count thresholds to qualify as a QP will increase under statute, making it more challenging for clinicians to qualify for this track of the QPP. The CNS and AANS are working with Congress to extend the APM incentive and freeze eligibility thresholds at their current level.
CMS Releases CY 2025 Medicare Hospital OPPS and ASC Proposed Rule
On July 10, CMS released the proposed rule for the calendar year (CY) 2025 Hospital Outpatient and Prospective Payment System (OPPS) and Ambulatory Surgery Center (ACS) Payment System. CMS proposes to update hospital outpatient payments by 2.6%. Comments are due on Sept. 9.
- A link to the proposed rule is available here.
- A CMS OPPS/ASC press release is available here.
- A CMS OPPS/ASC CMS fact sheet is available here.
Washington Office staff will be preparing a list of issues of interest to neurosurgeons and helping to draft letters for review by leadership. Initial issues of interest include:
- Separate Payment for Non-opioid Pain Treatment. CMS is proposing to implement a provision of the Consolidated Appropriations Act (CAA) of 2023, which provides temporary additional payments for certain non-opioid treatments for pain relief in the hospital outpatient department (HOPD) and ASC settings from Jan. 1, 2025, through Dec. 31, 2027. They have identified seven drugs and one device (the Elastomeric infusion pump, non-opioid pain management delivery system, including catheter and other system components) as qualifying non-opioid treatments to be paid separately in both the HOPD and ASC settings. The CNS and the AANS have supported separate payments for non-opioid products, especially for devices.
- Hospital Outpatient Quality Reporting (OQR) Program. CMS proposes to remove the following two measures from the program beginning with the CY 2025 reporting period/CY 2027 payment determination due to a determination that performance on the measures is not tied to better patient outcomes:
- MRI Lumbar Spine for Low Back Pain measure
- Cardiac Imaging for Preoperative Risk Assessment for Non-Cardiac, Low-Risk Surgery measure
Quality Improvement
2023 MIPS Final Score Preview Now Open
On June 28, CMS announced the opening of its 2023 Merit-Based Incentive Payment System (MIPS) Final Score Preview period, during which clinicians will have the opportunity to preview their 2023 MIPS final score prior to the release of payment adjustment information. As a reminder, 2023 final scores will determine 2025 MIPS payment adjustments. The Final Score Preview period helps CMS to ensure that it identifies any potential issues with performance scores before it calculates payment adjustments. Additional information can be found through the 2023 Final Score Preview FAQs and the 2023 Final Score Preview Supplemental Reports, available for download at the links provided and through the Quality Payment Program (QPP) Resource Library.
HHS Finalizes Information Blocking Disincentives
In late June, CMS, along with the Office of the National Coordinator for Health Information Technology (ONC), finalized regulations that establish disincentives for certain health care providers that have committed information blocking. Information blocking, as defined earlier through the 21st Century Cures Act (Cures Act) and subsequent regulation, is a practice that is likely to interfere with the access, exchange or use of electronic health information (EHI), except as required by law or specified in an information blocking exception. The Cures Act authorizes two separate enforcement mechanisms, depending on the “actor.” Health IT developers and health information exchanges/networks (HIEs/HINs) determined to have committed information blocking are subject to civil money penalties (CMPs) of up to $1 million per violation. Health care providers, on the other hand, will be subject to appropriate disincentives, which were finalized in this lates regulation.
The final regulation ties provider disincentives to three CMS programs:
- The Medicare Promoting Interoperability Program, which impacts Medicare payments to hospitals;
- The Merit-Based Incentive Payment System (MIPS), which impacts Medicare payments to clinicians; and
- The Medicare Shared Savings Program, which impacts Medicare payments earned through Accountable Care Organizations (ACOs).
CMS acknowledges that these disincentives would not cover all health care providers that might commit information blocking and expects to propose additional disincentives in the future.
Although the information blocking prohibition has been in effect since 2021, the government will not begin investigating health care providers or making determinations about their conduct until after July 31.
More information about information blocking and provider disincentives can be found here.
2022 QPP Performance Information Now Available on Medicare.gov Compare
CMS recently added 2022 Quality Payment Program (QPP) performance information to its publicly available clinician and group profile pages on the Medicare.gov compare tool and in the Provider Data Catalog (PDC). CMS is required to publicly report Merit-Based Incentive Payment System (MIPS) eligible clinicians’ final scores and performances under each MIPS performance category, as well as the names of eligible clinicians in Advanced Alternative Payment Models (APMs). Performance information for doctors and clinicians is displayed using measure-level star ratings, percent performance scores and checkmarks. To learn more about this public reporting initiative, visit the Care Compare: Doctors and Clinicians Initiative page.
2024 QPP APM Incentive Payments Now Available
CMS recently posted numerous resources alerting the public to the availability of incentive payments for eligible Qualifying Participants (QP) in APMs under the 2024 QPP. These resources provide details about APM incentive payments paid to QPs this year based on eligibility during the 2022 performance period; the process and methodology for identifying QPs and calculating incentive payments and a list of QPs with unverified banking information with instructions for how these clinicians can submit their billing information to CMS if they have not yet received a payment. Clinicians eligible for the incentive do not need to take any action to receive their payment unless CMS is unable to verify their Medicare billing information. However, clinicians with unverified banking information must verify their Medicare billing information by Sept. 1. After that date, any claim to an APM incentive payment for the 2024 payment period based on an eligible clinician’s QP status for the 2022 QP Performance Period will be forfeited.
2024 Learning Resources for QP Status and APM Incentive Payments available for download here or through the QPP Resource Library.
Of Note
Neurosurgeon Named President-Elect of AHA Eastern States Board
William W. Ashley, Jr., MD, PhD, MBA, has assumed the role of president-elect of the board of directors for the Eastern States region of the American Heart Association (AHA). Dr. Ashley is a founding member and past president of the American Society of Black Neurosurgeons. He is a senior member of the Society of Neurointerventional Surgeons, an active member of the CNS, the AANS and the CNS/AANS Cerebrovascular Section.
Click here to read AHA’s announcement.
Shelly D. Timmons, MD, PhD, Appointed Chair of Neurosurgery
Medical College of Wisconsin (MCW) announced on July 1 that Shelly D. Timmons, MD, PhD, has been appointed chair of the Department of Neurosurgery. Dr. Timmons has held numerous local, regional, national and international leadership positions in neurosurgery, including serving as CNS/AANS Washington Committee chair — the first female neurosurgeon in this role, and vice president of the Society of Neurological Surgeons. She currently heads up the American College of Surgeons Health Policy and Advocacy Group and serves on the Board of Regents of the American College of Surgeons and on the Accreditation Council for Graduate Medical Education Review Committee for neurological surgery.
Neurosurgeon Named MITRE VP, Center for Transforming Health
Stephen L. Ondra, MD, named MITRE vice president, Center for Transforming Health, and director of the CMS Alliance to Modernize Health Care. Dr. Ondra’s career has spanned the entirety of the health care ecosystem and he is a nationally recognized expert on health care reform and transformation. During the Barack Obama Administration, Dr. Ondra served as senior health policy adviser for health affairs at the U.S. Department of Veterans Affairs, in the Executive Office of the President as co-chair of the National Science and Technology Council for Health Information Technology.
Click here to read the announcement.
Communications
Neurosurgeons Featured in Wall Street Journal Op-Ed on Insurer-Driven Diagnoses in Medicare Advantage
On July 17, the Wall Street Journal published an op-ed titled, “The Games Insurers Play With Your Diagnosis.” Neurosurgeons Luis M. Tumialán, MD, and Mark A. Pacult, MD, comment on the rise of spurious insurer-driven diagnoses in Medicare Advantage. “The exploitation of patients and their diagnoses by insurers goes largely unchecked. Practices to undermine care to boost insurer profits at the expense of patients and physicians are widespread,” stated Drs. Tumialán and Pacult. “As independently practicing neurosurgeons, we have documented similar abuses by insurance companies.”
Neurosurgery Blog Features Neurosurgeon Awarded with TMA Foundation Heart of Gold Award
Texas Medical Association Foundation (TMA Foundation) recently awarded neurosurgeon Mark J. Kubala, MD, their highest honor, the Heart of Gold Award. On June 17, the Neurosurgery Blog posted an article highlighting Dr. Kubala as the award recipient. The foundation presents the award to outstanding individuals who embody a “gold standard” of volunteerism and have made a measurable impact on the foundation’s mission through gifts and leadership. A champion of the TMA Foundation for more than three decades, Dr. Kubala had a vision in 1994 of the critically needed physician-led public health programs the foundation could support. The Hard Hats for Little Heads bicycle helmet giveaway program for Texas children was born partly by his backing.
Neurosurgery Blog Completes Series on Making and Maintaining a Neurosurgeon
The Neurosurgery Blog concluded its focus series on the process of becoming a neurosurgeon. Read the complete series:
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