Average days to a first neurologist visit, Medicare
163,313 patients referred by 84,975 physicians to 10,250 neurologists.
Epilepsy, marked, is the indication a neurodiagnostic study exists to resolve. A patient with it waits ten days longer than a patient with back pain. Source: Callaghan et al., Neurology, January 8, 2025.
Everyone assumes this is a shortage. The data says it is not.
Five times the supply, same wait. If more neurologists does not mean shorter waits, then the capacity is not missing, it is being spent somewhere other than on the people waiting. That is not a workforce problem that a training pipeline fixes in a decade. It is an allocation problem, and allocation in U.S. health care follows the money.
A neurodiagnostic study is not paid for as a question that got answered. It is paid for as a procedure that happened, at a price attached to a code, on a schedule reset once a year. The device is upstream of the code, and the code is upstream of the price. Engineering moves the first of those three and nothing else.
Where the ceiling is set
A manufacturer owns the left half of this diagram and none of the right half.
The code that carries the payment is defined outside the transaction, and the price attached to it is reset on an annual schedule. A manufacturer can change what the study does and how quickly it does it. It cannot change the category the payment travels in.
This is a revenue argument, not a product one.
One
Natus can shorten the study, sharpen the algorithm, move it to the bedside, and the payment will not follow, because the price is attached to a code that describes what was done rather than what was resolved. Every incremental dollar of engineering meets the same fixed ceiling. That is an architecture problem, and it is the one thing a manufacturer cannot engineer past.
Two
If payment recognizes the clinical risk resolved rather than the procedure performed, a diagnostic that settles a question early, definitively and closer to the patient is worth materially more than one that does not, and for the first time that difference is legible to the people who pay. Neurodiagnostics fits that logic unusually well, because the entire value of the study is the risk it retires.
Three
A manufacturer cannot write a payment standard and neither can an investor. It takes the billing rails hospitals already run on, a classification of clinical risk with real grounding behind it, and somebody who can prove the effect in live claims and clinical data at scale. Forward Health Group has developed a reimbursement model on exactly that foundation. Who we build it with is governed by agreements that bar us from naming them on a public page, and we honor that in every direction, including yours. Michael will tell you across the table what we cannot print.
If the standard pays for risk resolved earlier, the fifty days come down.
That is not a side effect. The evidence above says capacity is being misallocated rather than missing, and allocation follows payment. A model that rewards resolving a patient's question early pulls capacity toward the people who are waiting. The same change that re-prices the category is the change that gets somebody with epilepsy seen in less than forty days, and gives the neurologist a working day that does not end at a kitchen table.
Increased patient access and reduced clinician burden are two of the four things this company was built to move. We have been publishing peer-reviewed research on practice culture, clinician burnout and patient outcomes since 1996. This is not a new interest and it is not a thesis we picked up for this meeting.
ARCHIMED has owned Natus Neuro in Middleton since July 2022. We are on South Pinckney Street in Madison, about ten minutes away, and we have been here the whole time.
Forward Health Group exists because we lost people very close to us to a system that was inefficient and broken. That has not stopped being the reason.