pRACTICING NEUROLOGISTs & aDMINISTRATORs

Telemedicine and Remote Care

Traditional medical practice is not always the most efficient or convenient way to provide care to our neurology patients. With an increasing demand for neurologic services in a growing population, technology can be one way to extend our reach to our patients. As technologies develop, it is paramount that practitioners maintain high-quality care, equivalent to traditional in-person visits.

Between easing logistics for patients who can't get to care sites, caring for an aging population, and coping with the ongoing dearth of neurologists, remote care will become more and more essential. People are increasingly becoming aware that telemedicine is an integral part of value-based patient care,
Eric R. Anderson, MD, PhD
Neurology Today: August 17, 2017 - Volume 17 - Issue 16 - p 1,22–23

Frequently Asked Questions

Q. What is telemedicine?
A. From the American Telemedicine Association: Telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve patients' health status. Closely associated with telemedicine is the term "telehealth," which is often used to encompass a broader definition of remote healthcare that does not always involve clinical services. Videoconferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education and nursing call centers are all considered part of telemedicine and telehealth. Telemedicine is not a separate medical specialty. Products and services related to telemedicine are often part of a larger investment by health care institutions in either information technology or the delivery of clinical care. Even in the reimbursement fee structure, there is usually no distinction made between services provided on site and those provided through telemedicine and often no separate coding required for billing of remote services. Telemedicine encompasses different types of programs and services provided for the patient. Each component involves different providers and consumers.

Q. How is telemedicine used in neurology?
A. Telemedicine in neurology has primarily been used to treat acute stroke patients in hospitals where neurologic experts are not available. Telemedicine is commonly used and well-accepted in acute stroke. More recently, telemedicine is expanding to routine neurology cases, for inpatient, outpatient, and consultation services.

Q. Does telemedicine replace the physical exam?
A. The telemedicine exam is limited, and several components are unable to be directly assessed. Often times, a trained telepresenter is used to provide patient exam components byproxy. The telemedicine exam cannot replace an in-person exam, but when properly utilized, can be a well-accepted surrogate in hospitals and areas where no neurologist is available.

Q. Can all patients be seen over telemedicine?
A. In cases where crucial physical exam components cannot be captured or assessed by the remote neurologist, care over telemedicine may not be appropriate. In these cases, an in-person exam may be recommended. Some examples of exam components that may require an in-person exam include the fundoscopic exam, subtle neuromuscular findings, brain death examination, and neurovestibular examination.

Q. How do I get reimbursed for providing telemedicine services?
A. Reimbursement for telemedicine is a dynamic and evolving topic. Medicare reimbursement varies from state to state. Medicaid is a national program and requires specific qualifiers to be met, and private insurance varies in reimbursement and by region. 

Q. How can I get licensed to practice telemedicine?
A. The practice of telemedicine occurs where the patient is located, and the remote physician must be licensed in any state that he/she plans to practice in.The Federation of State Medical Boards (FSMB) has initiated the Interstate Medical Licensure Compact. The Compact offers a streamlined licensing process for physicians interested in practicing medicine in multiple states and facilitates new modes of health care delivery such as telemedicine.

Q. What tools/equipment/software are needed to practice telemedicine?
A. The pace of technological innovation is rapid and new devices and mechanisms are continuously being unveiled. For medical applications, all tools and software must meet HIPAA standards. Practically speaking, it is always best to use vendors with good support and ability to address any technical issues rapidly. The American Telemedicine Association has a searchable Resource Center and Buyer's Guide that may be helpful.

Q. Do I need medical malpractice for telemedicine?
A. A physician should be insured with medical malpractice in every state that they practice. There are an increasing number of national or multistate insurers who are willing to insure in multiple states for the practice of telemedicine. Policies and rates change and vary based on a multitude of factors and it is recommended that you review the options available to you.