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kahnGuest post from Elyne N. Kahn, M.D., M.P.H.
Neurosurgery Resident, University of Michigan Health System

Dr. McCoy could employ medical holograms to treat complex medical ailments in his Star Trek co-travelers. While we have not realized this technological breakthrough, we have moved in that direction in the form of telemedicine.

Telemedicine, defined as the remote care of patients, aided by web-based or telephone-based telecommunications technology, has seen substantial growth in the past twenty years, due to technological advancements and evolving reimbursement policies. At the federal level, modern telemedicine reimbursement policy began with the “Balanced Budget Act of 1997.” The Act introduced, for the first time, reimbursement for telemedicine services provided to Medicare beneficiaries. Since then, federal and state policies have consistently expanded opportunities for reimbursement.

The primary benefits of telemedicine are threefold:

  • Reduce costs through diminished travel times and lost work time for patients and by avoiding unnecessary ED visits, transfers and hospitalizations;
  • Improve access via remote consultation of subspecialty experts, such as neurosurgeons; and
  • Improve outcomes, via remote consultation to assist with triage and care in time-sensitive scenarios, including acute stroke care and “teletrauma.”

Despite this, actual utilization of telemedicine remains limited, due to several barriers highlighted in Figure 1. Systems in which some of these concerns have been obviated, such as the Veterans Administration, telemedicine has been implemented extensively and to very good effect.

tele

Figure 1

Of relevance to the practicing neurosurgeon who is interested in learning more about telemedicine policy, the American Telemedicine Association maintains an up-to-date, online State Policy Resource Center that provides detailed, state-by-state overviews of laws and policies relevant to the practice of telemedicine. In addition, the American Medical Association is actively engaged on this issue.

Continued growth of telemedicine is assured, and the practice is likely to become increasingly integral to neurosurgery. The future of telemedicine will likely involve:

  • Reducing barriers through legislation and payment reform;
  • Refining scope through market forces;
  • Defining outcomes through robust research and clinical trials; and
  • Refining formal guidelines through state boards and professional organizations.

Ultimately, it will be up to us as providers to capture the promise of telemedicine and to ensure that its implementation is judicious and patient-centered so our patients have access the highest quality of care. The AANS and CNS are actively involved in promoting sound policies regarding telemedicine, so stay tuned for future posts on this topic.

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