All-Access Telestroke
Only 56 telestroke programs in the United States connect to an average of seven hospitals each—a fraction of the more than 5,600 hospitals in the country, according to a 2012 study in Stroke. Most telestroke programs run what's called a hub-and-spoke model, with the hub at an urban hospital and the spokes at rural community hospitals or emergency care facilities.
So why isn't every hospital in the country linked to a telestroke hub? The biggest stumbling block is reimbursement and financial viability. The American Telemedicine Association reports that 29 states have passed regulations requiring private insurers to cover telemedicine services in the same way they cover in-person care, but these laws vary from state to state. Differences include allowed distance between provider and patient, authorized technologies, payment methods, and services covered.
For public insurance, the problem is lack of comprehensive support by Medicare, says E. Ray Dorsey, MD, MBA, director of the Center for Human Experimental Therapeutics at the University of Rochester Medical Center in New York. Created in 1965 to provide care for 50 percent of elderly Americans who had no health insurance, Medicare isn't flexible enough to keep pace with changes and innovations in technology, he says.
How Medicare reimburses for telestroke is critical because when Medicare makes changes to its payment policies, the rest of the market follows.
Medicare's current reimbursement rules allow neurologists to bill for telestroke services when the patient is located in a rural hospital. In June 2015, Representatives Morgan Griffith (R-VA) and Joyce Beatty (D-OH) introduced a bipartisan bill called the Furthering Access to Stroke Telemedicine (FAST) Act to expand Medicare coverage of telestroke to include suburban and urban areas as well.
In a September 2015 opinion piece in The Hill, Griffith and Beatty cite a 2013 study in Telemedicine and e-Health that showed telestroke increased the use of tPA by two- to six-fold. The American Heart Association (AHA)/American Stroke Association estimates that if Medicare's coverage of telestroke were extended to suburban and urban areas, more than 22,000 additional Medicare beneficiaries would be treated with tPA annually.
Both the AHA and the American Academy of Neurology (AAN) are pushing Congress to act on the FAST Act. "This bill is exactly the type of legislation Congress is looking for, something that improves patient care and saves money. Telestroke will reduce the need for inpatient rehabilitation and skilled nursing services and save Medicare more than $1 billion over 10 years," says Mike Amery, legislative counsel for the AAN. As of May 11, 2016, the FAST Act has 89 cosponsors in the House of Representatives.
How can consumers influence this process? "Write to your representative in Congress," says David Tong, MD, director of California Pacific Medical Center's telestroke program. Or go to the National Stroke Association website, stroke.org, and look for the FAST Act Action Alert link to make your voice heard.