TeleNeurology as a Model for Telemedicine Growth: Part 1
Emergency teleNeurology and teleStroke care—the virtual delivery of stroke and emergency neurology specialists to the patient’s bedside using videoconferencing technology—has grown in magnitude, impact and validation. Earlier in the decade only a few hundred patients each year were connected to specialists by video conferencing; in 2018 literally thousands of patients will have a distant specialty neurologist involved in the critical phases of their care.
The typical assumption is that the growth of teleNeurology and teleStroke services (and telemedicine in general) is because technology has evolved and improved to become an ordinary necessity. In reality, the driver has always been financial, not technical. By providing access to board-certified neurologists, hospitals can retain more patients and more revenue.
TeleNeurology provides evidence-based care to patients even when a board-certified neurologist isn’t physically on site. Patient acceptance is high, the technology is proven to support good clinical results, and distance-based practices are capable of measurable clinical impact.
Supply Shortages and Uneven Distribution
There are about 759,000 people who suffer strokes each year, and neurologists are in scarce supply in many communities. According to a 2016 HRSA report, “this shortage is posing challenges for dedicated neuroscience programs and health systems, and by extension, for recruiters. The supply of neurologists will grow by 11% between now and 2025, while demand is projected to grow by 16%.” And the gap cannot be filled by mid-level practitioners, as it has been with other specialties.
There is also an uneven distribution of neurologists; most are concentrated in urban areas with large academic health centers. Rural hospitals have trouble attracting many specialists, including neurologists. This is not just because they can’t pay them as much, but also because they can’t guarantee a reasonable schedule. Strokes don’t just happen between 9 and 5.
Retaining specialists is also important to financial success. Increasingly, local physicians are realizing that telemedicine can be used to enhance, and not burden, their practices, and in the case of on-call coverage, can help them focus on their core practice and prevent burnout while actually expanding their patient population.
An Operational Model for Success
The model for hospital-supported teleNeurology has been relatively easy to define because about 60-70% of emergency neurology cases referred to expert neurologists by telemedicine are acute strokes and other neurovascular events. In this narrow collection of diagnoses, it’s been possible to build a reasonable predictive model for hospital return-on-investment against the costs of locum tenens neurologists. These services are demonstrating the values that telemedicine has always promised: efficiency, distribution of talent free of geographic restraints, and real benefits for patients and hospitals.
The successful evolution of teleNeurology and teleStroke now provides an operational model for the effective distribution of other specialty services by telemedicine.
Not all specialties lend themselves to the financial model that supports teleNeurology and teleStroke care. But all telemedicine strategies that deliver combined efficiency and quality will eventually find support from a party at-risk for the costs of poor care. The days of pilot projects are over. Telemedicine providers are ready to deliver clinical care in multiple specialties. As a model for care, teleNeurology has explored interesting ground that serves as a foundation for other telemedicine specialties.
Coming soon, TeleNeurology as a Model for Telemedicine Growth: Part 2… How CEOs should evaluate new service lines for telemedicine