Strokes cost an estimated $34 billion in the US every year. A large portion of that price tag is preventable.
Stroke is the leading cause of serious long-term disability in the United States. Each year, more than 800,000 Americans experience a stroke — the long-term of effects of which can include weakness, paralysis, pain, incontinence, speech problems, difficulty swallowing and problems with vision and memory. Treatment of these complications can require nursing home placement when patients are discharged from the hospital, followed by months or years of outpatient rehabilitation.
Strokes also come with a serious price tag. The American Heart Association reports that strokes cost an estimated $34 billion each year in the U.S., including costs associated with healthcare services, medications and lost time from work. But a large portion of these “downstream” costs of stroke — associated with disability and lost productivity — are preventable if patients receive proper care quickly. Because the majority of patients experiencing stroke symptoms go to the emergency department (ED) for treatment, the ED’s ability to staff or access specialized stroke care can mean the difference between life and death, even the difference between profound stroke-related disability and the ability of a patient to optimize recovery. Access to this specialized care can also mean the cost of a patient’s treatment trajectory can be substantially reduced over time.
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But this sort of care can be tough to get. So, how can hospitals ensure access to high-quality stroke care, reduce the economic cost of caring for acute stroke patients and save more lives? Telemedicine is the answer.
A segment of acute care telemedicine that continues to gain prominence is neurology. Teleneurology is making it possible to connect patients with highly qualified, board-certified neurologists within minutes, ensuring prompt patient care and decreasing the likelihood of long-term stroke-related disability.
Landmark studies have long demonstrated the effectiveness of the clot-breaking therapy called tPA in the treatment of ischemic strokes (those cause by blood clots). Because ischemic strokes account for the vast majority of all strokes, today the administration of tPA is recommended for a large percentage of stroke patients. Patients given tPA within three to four hours of symptom onset are less likely to experience stroke-related mortality and long-term impairments compared to patients who don’t receive the drug.
While tPA is not recommended for all patients, telestroke programs are showing their doctors prescribe tPA in 20-25 percent of cases vs. the national average of 5 percent. Because teleneurologists support multiple facilities across multiple states, the number of stroke patients they care for is far greater than those seen by an on-premise neurologist. With that volume of stroke care, teleneurologists increase their familiarity with strokes and corresponding symptoms and subsequently provide better diagnosis of clot-based strokes, which allows for more accurate prescription of tPA. Despite prescribing tPA five times as often as on-site peers, teleneurologists also prescribe it more accurately, with a bleed rate that is half the national average.
There is no doubt that EDs are on the frontline of defense for acute stroke care management. An assumption that underpins the efficiency of emergency stroke care is that there are adequately trained neurologists available to provide this care. But what if there aren’t? An ongoing concern among stroke experts is the shortage of neurologists overall and an even greater scarcity of neurologists who specialize in stroke and are immediately available to evaluate patients in an acute setting. Additionally, disparities in access to healthcare services due to geographical barriers such as rural markets and limited resources are amplifying the issue.
Many of these challenges in access to neurologists are linked to allocation — where, when and how many. Integrating telemedicine into patient care has proven to be beneficial, enabling fractionalization of capacity across multiple facilities, deployment to disparate hospitals and best use of limited resources and expense management.
Use of telemedicine for strokes is becoming the standard of care. The 2018 American Heart Association/American Stroke Association Guidelines for early management of patients with acute ischemic stroke include a section dedicated to the key role telemedicine plays in the management of acute stroke care. Some key points the guidelines include concerning telemedicine include:
Together, these recommendations for the use of telemedicine, along with data from the National Institute of Neurologic Diseases and Stroke (NINDS) supporting cost savings, provide firm rationale for the adoption of telestroke.
Financially, the numbers speak for themselves. Analyses from the American Heart Association on the costs and savings of telestroke support for Medicare beneficiaries recently concluded that the more than $222 million in cost savings attributed to needing less rehabilitation and nursing home services can, in fact, offset the $103 million in increased costs for these services — yielding a net gain of more than $119 million. These savings also extend to health systems that adopt telestroke care for their patients.
One thing is clear: Telemedicine is succeeding in meeting the challenges of providing exceptional acute stroke care, generating better patient outcomes, providing access to on-demand stroke care specialists and showing clear improvements in the quality of care. All of this while achieving increases in patient volume and revenue for the hospitals and health systems taking advantage of these services.
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Hammad Shah oversees the corporate direction and strategy for SOC Telemed and has more than 20 years of experience in healthcare leadership, serving in senior administrative, strategic and operational roles. His expertise crosses many disciplines, including product development, sales, process improvement and mergers and acquisitions. Shah’s work spanned the globe during a time when countries in Asia and Europe, such as China, Singapore, Germany and the United Kingdom, were undergoing significant efforts to reform their healthcare systems. This has given him the deep understanding required to aid organizations in assessing how to operate in rapidly changing healthcare markets.