How telestroke has paved the way for broader teleNeurology services
By Dr. Eric Anderson
Telestroke was one of the first implementations of teleNeurology, and opened the door for other uses of telemedicine in neurology. Today, it remains one of the foundational and most requested neurologic services overall. Despite its proliferation, it didn’t change the fact that a local neurologist was still not present or available to provide follow up care for the local patients at these hospitals, or consult on non-stroke neurologic patients.
The Range of Services Expands
The next logical step was to provide follow up care for post-stroke patients as well as other inpatient services, and we began to test the boundaries of what other neurologic services could be offered using telemedicine. Typically, a teleNeurologist would first be asked to weigh in on a stroke case at a hospital that didn’t have a neurologist on staff. If that patient remained at the hospital for further care, the hospital would still need the services of a neurologist for follow-up. So, we started offering inpatient visits and consultations in order to allow the patient to stay at the hospital and reduce unnecessary transfers. That natural evolution continued, as hospitals expanded their service requests to include non-stroke patients such as those with epilepsy, movement disorders, and encephalopathy. That logically evolved to include further ancillary services, such as remote EEG readings and interpretation of images.
Sub-Specialties Begin to Flourish
Neurologists frequently sub-specialize following residency in the fields of cognitive care, movement disorders, epilepsy, and several others. However, it’s often difficult to build a subspecialty practice that only services a specific disease state. Thus, neurologists typically build a practice as a generalist who also has a focus in some sub-specialty.
Within a telemedicine model, neurologists can practice across several hundred hospitals and rapidly build a population of disease-specific patients that can support their preferred sub-specialty practice. Hospitals can then have access, not just to a general neurologist, but to subspecialists with deep and focused expertise. The evolution and growth of telemedicine networks now allows us to supply a population of disease specific patients to support the use of fellowship-trained specialists in an effective and affordable way that otherwise wouldn’t be possible.
Benefits That Go Beyond Reimbursement
For both hospitals and patients, telestroke is a mainstream approach to providing care. Not only do hospitals and physicians understand its benefits, but patients have come to expect it. Additionally, with changes in reimbursement and legislation, it’s become an obvious service for hospitals to offer to their patient population. With the increase in telestroke’s acceptance and availability, the expansion of services beyond telestroke is the next logical step.
Historically, reimbursement has been one of the major stumbling blocks to the implementation of a telemedicine program. Initially, telemedicine programs were primarily grant-funded and relied on public funds or private donations to make them a possibility. However, in February 2018, when President Trump signed into law the FAST Act (the Furthering Access to Stroke Telemedicine Act, which both the American Stroke Association and the American Academy of Neurology were heavily involved in supporting) a new mechanism was introduced that could sustain a telestroke practice outside of grants. A year later, Congress passed a short-term funding package that included two years of funding for the FAST Act. This means that 2019 is the first year that Medicare has been required to reimburse facilities for stroke care via telemedicine in both urban and rural areas as opposed to just rural areas, as it was in the past.
Reimbursement aside, hospitals have many reasons to provide telemedicine services. Its use improves the ability of the hospital to provide care for their patients while keeping them close to home, and also improves the quality of the care they can provide. It affects their bottom line because they’re able to properly diagnose patients and treat them appropriately while avoiding unnecessary transfers.
Where Do We Go From Here?
Telestroke paved the way for telemedicine in neurology, and it has organically grown to include inpatient and other areas of care. In the future, I believe we will be able to bring the expertise of sub-specialists to see disease-specific patients in a very organized and affordable fashion. I imagine hospitals will have access to an epileptologist to see the person who has recurrent seizures, a stroke expert to see the person who had a stroke, and a movement disorder specialist to see the person with poorly defined involuntary movements. The end result is that hospitals will be able to provide the highest level of expertise and care, at the right time, to the right patient on a national level through teleNeurology.
Dr. Eric Anderson, Chair of Neurology at SOC Telemed and leader of SOC’s Neurology Council, is an innovative physician-scientist who’s been recognized as a national leader in telemedicine and mobile health. He trailblazed the use of mobile telemedicine in emergency neurology and was the first to demonstrate and publish that remote stroke assessment could be performed with an iPhone. He speaks nationally on the topics of telemedicine as it applies to stroke, epilepsy, and neurologic disease. He currently practices telemedicine in 32 states and at over 240 hospitals, and is the Director of Telemedicine for Corticare, a national neurotelemetry company based in Carlsbad, CA, and serves as the Vice Chair of Quality as well as the subject matter expert on Tele-EEG for SOC Telemed. He also devotes his time to operating Intensive Neuromonitoring, a Tele-EEG company in Georgia that specifically caters to private practices and small hospitals. Dr. Anderson leads several efforts in bringing telemedicine and technology to the forefront of medicine.