For years telehealth has been an untapped resource for many healthcare organizations due to concerns around reimbursement constraints and initial overhead costs of implementing the program. Existing telehealth operations have primarily focused on patients who live in rural or underserved regions that have these services covered by Medicare, typically within targeted programs such as telestroke. In addition to geographic restrictions put in place by Medicare, services are typically required to have been provided at a hospital, clinic, nursing home, or physician’s office.
In 2020 Medicare Advantage plans to eliminate many of these barriers, making telehealth a base benefit available under Part B. Many restrictions for key users of telehealth, such as telestroke and dialysis patients, will be eliminated. Additionally, geographic barriers for telestroke and dialysis patients will be removed, improving access for patients living in urban and suburban areas who may have limited mobility, transportation concerns, or simply want improved access to care.
This change in Medicare reimbursement is important because CMS tends to set the pace for commercial payers, indicating improved telehealth reimbursement across the board. From 2014-2017, commercial telehealth claims grew 261%. This trend will continue as the technology becomes more accessible and favorable to remote patients and providers alike, both operationally and financially.
Telehealth advocates claim that the technology improves patient access, clinical outcomes, provider efficiency, and systemization. As we position for the future of telehealth, neurology is anticipated to be a key area for growth, particularly for those in remote areas lacking access to specialized care.
Applications in Teleneurology
Telestroke was the first widely adopted teleneurology application. Broader teleneurology applications have been implemented across the continuum of care within triage and diagnosis, emergency and acute care, remote monitoring in the neuro-ICU, and care management for chronic patients with degenerative diseases like multiple sclerosis, epilepsy, and dementia, where mobility issues and access to care are burdensome.
Trends driving teleneurology adoption are symptoms of healthcare’s broader need for telemedicine:
- Provider shortages. National physician shortages, especially within neurology, have caused capacity constraints and challenges to meet demand. A projected shortfall of 19% from neurologist demand is expected in 2025.
- Poor service distribution. Neurology services are highly specialized and often not available locally, especially in rural areas, requiring patients to travel hours for acute services and chronic care management. For example, Washington D.C. has 11.02 neurologists per 100,000 people versus 1.78 per 100,000 in Wyoming.
- Access causing delays in care. Access issues lead to delays in care, which can be detrimental for advanced or emergency patients, worsening patient outcomes. Patient satisfaction scores also suffer due to delays in care: 76% of patients prioritize access to care over need for human interaction with providers.
Identify Your Opportunity
Adopting teleneurology (and broader telehealth) services provide both strategic and operational opportunities for your organization.
Strategic Opportunities
Teleneurology offers systemization, providing specialized expertise across your system and within spoke locations via telehealth connections to your hub. Systemization presents several benefits:
- Improved access for remote patients
- Increased market share and capture of patient encounters
- Capacity relief in highly utilized hub locations
- Competitively establishes your system as a regional neuroscience center, resulting in increased referrals both within and outside of your network
- Leverages system strength to negotiate higher reimbursement rates from payers
Teleneurology also allows you to capture patient volumes in remote populations who forgo care due to access challenges, letting you:
- Target your existing populations with care gaps
- Leverage existing assets within your system that can serve as a spoke to provide remote teleneurology solutions in partnership with your hub
- Capture additional market share in remote areas that traditionally have less system loyalty
Operational Opportunities
Numerous operational efficiencies can be realized through treating patients via teleneurology/ telehealth, even when the patient is not in a remote location. This is particularly true for hub locations that have capacity constraints.
- Scheduling. Telehealth reduces the number of no-shows, providing care to the patient in their own home when appropriate. Omaha’s Children’s Hospital & Medical Center found that telemedicine reduced their no-show rate for follow-up visits by 50%. Plus, 90% of patient families surveyed reported being “very satisfied” with their encounter, with the other 10% saying they were “satisfied.”
- On-site capacity. Operational efficiencies are improved by keeping patients out of the clinic/hospital, including increased staff capacity and reduced turnover time.
- Follow-up care. Teleneurology increases the likelihood that patients attend follow-up visits, which is especially important when managing chronic patient populations.
- Patient retention and increased revenues. Convenient access to specialized care drives patient loyalty and revenues; studies show patient retention is 60-70% on average following telemedicine consultations in neurology.
- Better timeliness of care and effective treatment of stroke and other emergent patients improve outcomes for these patients.
Telemedicine provides strategic and operational opportunities in addition to effective solutions for challenges that rural and remote healthcare providers face in providing patients with access to care. Broad teleneurology applications have been adopted across the care continuum to overcome barriers that many other specialties face. As telehealth reimbursement continues to improve, it is critical that telehealth applications are implemented to meet patient demand and access, especially in rural areas lacking access to specialty care.
