Lawmakers on Tuesday were urged to support expansion of long-distance, technology-driven healthcare — known as telehealth – for  more patients in remote locations who need timely medical care at facilities that lack stroke expertise.

Dr. Ralph Sacco, MD, past president of the American Heart Association/American Stroke Association and chairman of neurology at University of Miami Miller School of Medicine, told a roundtable hosted by the U.S. Senate Special Committee on Aging that telehealth is necessary to provide access to high-quality stroke care.

“This use of telemedicine in the acute treatment of stroke has greatly helped to improve the percentage of patients who receive the recommended acute stroke treatment and thus have reduced disability and lowered costs,” said Dr. Sacco.

Telemedicine and telestroke care are gaining traction around the country. Experts told committee members about the growing interest due to overuse of hospital emergency rooms, long waits for primary care and specialist appointments, and lack of access to timely care. They noted that telemedicine can improve coordination and reduce fragmentation.

However, Dr. Sacco and other experts remarked that barriers remain, including cross-state medical licensing and lack of infrastructure. In addition, there are limitations to Medicare reimbursements for services originating in rural areas. Technology has outpaced regulation, making reimbursement an issue.

“We particularly encourage Congress to address the Medicare reimbursement barrier and help make telestroke care more widely available,” Dr. Sacco said in his  prepared testimony.

“The Medicare policy of limiting reimbursement for telehealth services to those originating in only rural areas has hampered the development of sufficient stroke consultation coverage.  We urge Medicare to expand coverage for telestroke consultations beyond that of rural regions. “

Dr. Sacco noted that telestroke care has proven to be a lifesaver for those being treated at facilities that lack neurology expertise. He pointed to recent studies that showed a six-fold increase in the number of stroke patients receiving the clot-busting drug tissue plasminogen activator (tPA).

Stroke is the No. 4 killer of Americans, a major cause of serious, long-term disability, and the second leading cause of dementia.  Approximately 795,000 people experience a stroke each year in the United States, and about 70 percent of the total hospitalizations for stroke occur among adults ages 65 and older.

With telestroke care, an emergency department physician in one location can reach a stroke specialist at another location using a range of audio-video systems and even Internet-based methods, including Smartphone apps. An evaluation of the patient can be performed by sending diagnostic images, such as computed tomograph scans to hospitals that are connected via audio-video systems. Some smartphone apps now feature diagnostic imaging software, suggesting that stroke evaluation can be portable. Stroke experts can review images from any location and provide a medical opinion on treatments from any distance. In fact, a 2012 study published in Stroke, a journal of the American Heart Association, found that the app ResolutionMD provided vascular neurologists access to radiological images of stroke patients that led to timely and effective care.

“This use of telemedicine in the acute treatment of stroke has greatly helped to improve the percentage of patients who receive the recommended acute stroke treatment and thus have reduced disability and lowered costs,” said Dr. Sacco.

Even as telemedicine continues to rapidly evolve with more telemedicine companies attracting patients, lawmakers who support the use of broadband, web-based and other software applications to better connect patients with physicians question how telemedicine will affect licensing, prescribing practices, the physician-patient relationship and reimbursement.

Former U.S. Senator John Breaux, a Democrat from Louisiana, moderated the roundtable. He said one of the biggest challenges Congress faces will be to clearly define what telemedicine is, which will make it easier  for Congress to regulate.

“The laws” he said, “have to catch up with the technology.”

Photo by Courtney Doby