Abstract:This review presents evidence of the value and effectiveness of telestroke programs, as well as an explanation of common barriers and facilitators of telestroke, including licensing and credentialing rules, reimbursement issues, and liability concerns. Most states have adopted policies that affect the adoption of telestroke programs. Georgia and South Carolina are examples of states implementing stroke policies using a telestroke model to treat stroke patients in rural areas.
“…While licensing requirements can vary from state to state, they are largely similar 6. In spite of this near uniformity in licensing requirements, there is enormous state to state variability in telestroke specific licensing 7. For instance, Louisiana and Minnesota are two of nine total states that permit clinicians with an out of state license to practice telemedicine within their state 8 9.…”
Section: Expanding Access To Telestrokementioning
confidence: 99%
“…For instance, Louisiana and Minnesota are two of nine total states that permit clinicians with an out of state license to practice telemedicine within their state 8 9. Conversely, eight states specifically require telemedicine physicians to obtain an in-state medical license 7. Six states do not address telemedicine at all, while most other states have acknowledged telemedicine but made few provisions for its practice 7.…”
Section: Expanding Access To Telestrokementioning
confidence: 99%
“…Conversely, eight states specifically require telemedicine physicians to obtain an in-state medical license 7. Six states do not address telemedicine at all, while most other states have acknowledged telemedicine but made few provisions for its practice 7. Ultimately, the administrative burden of securing multiple state licenses per provider was recently cited as one of the biggest barriers to expanding a telestroke network 4.…”
Section: Expanding Access To Telestrokementioning
confidence: 99%
“…In 2011, Centers for Medicare and Medicaid Services (CMS) attempted to streamline credentialing by allowing credentialing by proxy compacts between referring hospitals and teleconsultants in a telemedicine network 16. In 2012, California was the first state to pass a law addressing hospital credentialing by proxy for physicians in a telestroke network, permitting local hospitals to credential remote physicians by proxy if they met practice requirements in their home facility 7 17 18. Nonetheless, the overwhelming majority of state laws make no provisions for reciprocal credentialing in a telestroke network 7…”
Acute ischemic stroke remains a major public health concern, with low national treatment rates for the condition, demonstrating a disconnection between the evidence of treatment benefit and delivery of this treatment. Intravenous thrombolysis and endovascular thrombectomy are both strongly evidence supported and exquisitely time sensitive therapies. The mismatch between the distribution and incidence of stroke presentations and the availability of specialist care significantly affects access to care. Telestroke, the use of telemedicine for stroke, aims to surmount this hurdle by distributing stroke expertise more effectively, through video consultation with and examination of patients in locations removed from specialist care. This is the second of a two part review, and is focused on the challenges telestroke faces for wider adoption. It further details the anticipated evolution of this novel therapeutic platform, and the potential roles it holds in stroke prevention, ambulance based care, rehabilitation, and research.
“…While licensing requirements can vary from state to state, they are largely similar 6. In spite of this near uniformity in licensing requirements, there is enormous state to state variability in telestroke specific licensing 7. For instance, Louisiana and Minnesota are two of nine total states that permit clinicians with an out of state license to practice telemedicine within their state 8 9.…”
Section: Expanding Access To Telestrokementioning
confidence: 99%
“…For instance, Louisiana and Minnesota are two of nine total states that permit clinicians with an out of state license to practice telemedicine within their state 8 9. Conversely, eight states specifically require telemedicine physicians to obtain an in-state medical license 7. Six states do not address telemedicine at all, while most other states have acknowledged telemedicine but made few provisions for its practice 7.…”
Section: Expanding Access To Telestrokementioning
confidence: 99%
“…Conversely, eight states specifically require telemedicine physicians to obtain an in-state medical license 7. Six states do not address telemedicine at all, while most other states have acknowledged telemedicine but made few provisions for its practice 7. Ultimately, the administrative burden of securing multiple state licenses per provider was recently cited as one of the biggest barriers to expanding a telestroke network 4.…”
Section: Expanding Access To Telestrokementioning
confidence: 99%
“…In 2011, Centers for Medicare and Medicaid Services (CMS) attempted to streamline credentialing by allowing credentialing by proxy compacts between referring hospitals and teleconsultants in a telemedicine network 16. In 2012, California was the first state to pass a law addressing hospital credentialing by proxy for physicians in a telestroke network, permitting local hospitals to credential remote physicians by proxy if they met practice requirements in their home facility 7 17 18. Nonetheless, the overwhelming majority of state laws make no provisions for reciprocal credentialing in a telestroke network 7…”
Acute ischemic stroke remains a major public health concern, with low national treatment rates for the condition, demonstrating a disconnection between the evidence of treatment benefit and delivery of this treatment. Intravenous thrombolysis and endovascular thrombectomy are both strongly evidence supported and exquisitely time sensitive therapies. The mismatch between the distribution and incidence of stroke presentations and the availability of specialist care significantly affects access to care. Telestroke, the use of telemedicine for stroke, aims to surmount this hurdle by distributing stroke expertise more effectively, through video consultation with and examination of patients in locations removed from specialist care. This is the second of a two part review, and is focused on the challenges telestroke faces for wider adoption. It further details the anticipated evolution of this novel therapeutic platform, and the potential roles it holds in stroke prevention, ambulance based care, rehabilitation, and research.
“…9 Still, cost-sharing measures or support from the state and federal level are necessary to make telemedicine networks economically feasible, as current reimbursement for telemedicine is limited by law to certain specialties and low-access communities. 10 Fee-for-service reimbursement traditionally requires in-person encounters, which teleneurology is not. The American Academy of Neurology supports the reimbursement of telemedicine encounters in the same fashion as face-to-face, telephonic, and e-mail clinical encounters.…”
Section: Teleneurology Network To Improve Access To Thrombolysis Formentioning
SummaryHealth care costs continue to rise toward unsustainable levels that will affect our nation's ability to support other key funding priorities for education, military, and infrastructure. Changing the way we deliver health care is critical to mitigating this financial crisis. This review highlights opportunities for redesigning care of acute ischemic stroke and TIA to maintain quality while substantially lowering costs. The recent innovations described are (1) adopting teleneurology networks to improve access to thrombolysis for acute ischemic stroke; (2) improving efficiency of emergency care for acute ischemic stroke; and (3) providing alternatives to inpatient care for TIA. Applying such process innovations will enable us to achieve the goal of patients and the nation-high-quality care at an affordable cost.A s government and private payer budgets tighten, and competing public sector goods continue to vie for limited financial resources from the government and private sectors, all stakeholders are taking a close look at health care value. Cost of care continues to rise and health insurance premiums continue to rise faster than inflation.1 Under the Affordable Care Act of 2010, more Americans will become insured, thus increasing the demand for health care resources.2 This will overtax an already overburdened yet inefficient delivery system.
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