Telehealth for Comprehensive Care of Acute Neurologic Disorders

Abstract

A teleneurology hospitalist model aims to address the demand for high-quality neurologic acute care and the shortage of neurologists. Here, we review concepts and models of teleneurology services to address access and care gaps in neurology beyond telestroke models. The goal of these emergent teleservices is to empower community hospitals to deliver the highest quality care, while also reducing unnecessary patient transfers to tertiary care hospitals. We highlight the clinical models, patient populations, and innovative approaches of different tele-neurohospitalist services. This includes challenges related to clinical limitations, legal issues, and reimbursement. We highlight specific areas of research that can further clarify and refine the appropriate use, cost-effectiveness, and clinical outcomes of these telemedicine-based care models.

Medicare Restriction of Telehealth Speech Services Negatively Impacts Patient Care

“…Implementation of telemedicine has increased significantly over time, with advances in technology and demand for patient‐centered, tertiary‐level care from specialists 13‐21 . This trend skyrocketed during the COVID‐19 pandemic, in the setting of lockdowns, social distancing, masking protocols, and concerns about aerosol‐generating procedures 13‐15,17,22‐25 .…”

“…[1][2][3][4]6,[8][9][10][11][12] Implementation of telemedicine has increased significantly over time, with advances in technology and demand for patient-centered, tertiary-level care from specialists. [13][14][15][16][17][18][19][20][21] This trend skyrocketed during the COVID-19 pandemic, in the setting of lockdowns, social distancing, masking protocols, and concerns about aerosol-generating procedures. [13][14][15]17,[22][23][24][25] In early March 2020, the Center for Medicare and Medicaid Services (CMS) drastically expanded access to telehealth services on a "temporary and emergency basis," covering a wide range of providers and services.…”

“…[13][14][15][16][17][18][19][20][21] This trend skyrocketed during the COVID-19 pandemic, in the setting of lockdowns, social distancing, masking protocols, and concerns about aerosol-generating procedures. [13][14][15]17,[22][23][24][25] In early March 2020, the Center for Medicare and Medicaid Services (CMS) drastically expanded access to telehealth services on a "temporary and emergency basis," covering a wide range of providers and services. This was a marked change from their earlier policy where "prior to this waiver Medicare could only pay for telehealth on a limited basis."…”