Anton syndrome as a result of MS exacerbation

article with interest. The description of the money a physician spends on patient care as a contribution is concerning, particularly as we focus more than ever on excessive health care spending in the United States. The accounting definition of contribution is the amount of earnings remaining after all direct costs have been subtracted from revenue. 2 The brief acknowledgement at the end of the article that the true contribution margin cannot be calculated is too little, too late. In the era of value-based medicine, the value of a neurologist can only be calculated when the cost of care is compared to quality. 3 Currently the clear majority of health care payments to institutions and physicians are tied to value and quality and the trend will continue. The detailed calculations performed in this article serve only to draw attention to the high expense associated with multiple sclerosis (MS) care, a fact that is already well-established in the literature and lay press. A more interesting exercise would be to try to show that MS care can be delivered efficiently (at lower cost) and effectively (with better outcomes) by academic health centers.