Telemedicine Neurology: A New Standard of Neurological Care

Telemedicine has already transformed the way healthcare is delivered. According to the AMA 2021 telehealth survey, more than 80% of physicians agree or strongly agree patients have better access to care since they began using telehealth. Telemedicine has also led to improvements in patient access and engagement.

With less need for in-person visits, practices see a decrease in cancellations and delays and even greater follow-through on doctor recommendations. Ensuring greater access to services is a win/win for both your patients and your practice. As the technology continues to advance and the world adapts to new ways of providing care, telemedicine neurology will continue to improve, offering more patients access to specialized treatment and new ways to manage their neurological conditions.

In this article, we'll explore the opportunities and challenges associated with telemedicine neurology: the benefits of delivering neurological care with telemedicine, patient experiences, reimbursement, and more.

Key takeaways

• On average, per week, neurologists see 36% of their patients via telehealth
• Neurologists use telehealth services to diagnose and treat conditions with improved outcomes. For example, a 2019 study found that telemedicine can improve adherence to disease-modifying therapies (DMTs) and management of debilitating symptoms such as fatigue in MS patients.
• Telemedicine provides cost reductions and increased accessibility to care
• Patient experience and outcomes are improved as health systems and insurers facilitate integration into healthcare delivery
• However, while telemedicine use is expanding across the vast array of neurologic disorders, more studies are needed to validate and support its use.

The Rise of Telemedicine in Neurology

The American Medical Association’s telehealth survey indicates that 98% of neurologists utilize telehealth, with many neurology departments and hospitals offering telehealth appointments for patient convenience. This innovative approach to healthcare delivery offers numerous advantages, including:

• Expediting care
• Increasing access
• Reducing costs
• Enhancing diagnostic accuracy and health outcomes

What Is Teleneurology?

Teleneurology is a subfield of telemedicine that specializes in providing remote neurological care through video consultations, remote monitoring, cognitive tests/tasks that can be performed remotely, and tele-education.

From evaluating memory loss to managing complex neurological conditions, telemedicine appointments (or video visits) enable patients to access specialized care without the need for in-person visits. UPMC, for instance, offers virtual visits via a patient portal for teleneurology appointments, ensuring patients have the required internet access and a compatible device for their video visit.

Neurology specialists who adopt teleneurology can diagnose, treat, and manage various neurological conditions. This approach provides patients with heightened convenience and accessibility. This has led to a growing acceptance of telehealth services among both healthcare providers and patients.

Neurologists and Telehealth

Telehealth enables neurologists to diagnose and treat neurological conditions without requiring an in-person visit, allowing patients to access care from the comfort of their own homes.

As more neurologists adopt telehealth, the benefits and potential applications in neurology are becoming more evident. From streamlining care delivery to improving accessibility, telehealth services in neurology have demonstrated their value in enhancing patient outcomes.

“Opportunities for telemedicine in neurological disorders include the replacement of or complement to in-office evaluations, decreased time between follow-up visits, reduction in disparities in access to healthcare, and promotion of education and training through interactions between primary care physicians and tertiary referral centers.”

Telemedicine in Neurological Disorders: Opportunities and Challenges, Telemed J E Health. 2019 Jul 1; 25(7): 541–550

Telemedicine Applications for Neurological Disorders

Telemedicine has been effectively utilized for the management of a range of neurological disorders, from stroke care to epilepsy management and multiple sclerosis monitoring.

By facilitating access to care, optimizing patient outcomes, and reducing costs for both patients and health systems, telemedicine has proven to be a game-changer in the field of neurology.

However, it’s crucial to recognize challenges associated with telemedicine for neurological disorders, which we'll cover in later sections.

Stroke Care

Stroke care has undergone significant improvements through the use of telemedicine, allowing for faster diagnosis and treatment, ultimately improving patient outcomes.

Telemedicine has been particularly beneficial in stroke care due to the time-sensitive nature of stroke treatment. With the use of telemedicine, healthcare professionals can rapidly diagnose a stroke and initiate treatment, even if the patient is in a remote location.

Telemedicine for stroke, often referred to as telestroke, typically involves a two-way, real-time interactive communication system between the patient and the remote specialist. This system allows neurologists to evaluate the patient, review brain imaging results, and make critical decisions regarding the best treatment plan.

In stroke care, time is of the essence. The sooner a stroke is diagnosed and treated, the better the patient outcomes. Telemedicine enables immediate access to specialized neurological care, reducing time to treatment and potentially minimizing the damage caused by the stroke.

Moreover, telemedicine can also play a crucial role in post-stroke management. Regular follow-ups and rehabilitation are essential parts of stroke recovery, and telemedicine can facilitate these, making the process more convenient for the patient. In essence, the real-time, rapid response capabilities of telemedicine make it an ideal tool in the management of stroke care, from immediate treatment to ongoing recovery.

Teleneurology for stroke has had a notable impact on the acute treatment of cerebrovascular diseases in numerous regions, and research suggests that telemedicine care, such as video or telephone interviews, is an appropriate option for individuals with stroke patients.

“Telestroke [stroke telemedicine] improves care and can save lives. Individuals who receive stroke care at facilities that offer consults via stroke telemedicine fare better than patients who get stroke care at places without such services.”

Telemedicine for stroke patients improves outcomes, The Harvard Gazette (2021)

During a 2022 discussion about telehealth and stroke care, Benjamin Kummer MD highlighted the utilization of telehealth for stroke care both before and during the pandemic, as well as its potential in the future, including the possibility of reducing the need for an office visit.

Epilepsy Management

Telemedicine has proven effective in managing epilepsy, with remote monitoring and consultations providing comparable results to in-person care. Research suggests that telemedicine care, such as a virtual visit, is an appropriate option for individuals with epilepsy.

The nature of epilepsy, with its unpredictable seizures and the need for ongoing medication adjustments, makes it a prime candidate for telemedicine. Through remote monitoring, doctors can keep track of their patients' seizure frequency and severity without requiring them to come into the clinic.

Telemedicine is especially beneficial for patients who live far from their healthcare provider or have mobility issues. Furthermore, virtual consultations allow neurologists to adjust medication dosages and discuss treatment plans with patients in real time. Finally, telemedicine also offers the opportunity for remote patient education. This can involve teaching patients and their families about seizure first aid, medication management, and lifestyle modifications that can help manage epilepsy.

“In our experience, tele-epilepsy is most effective and useful where the majority of the appointment is focused on clinical discussion, counseling and focused neurological examination only requiring inspection. It is most convenient and useful for patients living at considerable distances from the specialist care.”

Feasibility of epilepsy follow-up care through telemedicine: A pilot study on the patient's perspective, Epilepsia. 2008 Apr;49(4):573-85.

This innovative approach has not only improved the quality of care for epilepsy patients but also increased their access to specialized services.

While there may be some challenges when implementing telehealth services for epilepsy patients, the overall benefits and potential for improved patient outcomes make it a promising avenue for future development and innovation in epilepsy management.

Multiple Sclerosis Monitoring

Multiple sclerosis (MS) patients can greatly benefit from telemedicine through remote monitoring and virtual visits, reducing the need for frequent in-person appointments. Remote neurological assessments and several forms of therapy have been shown to be technically feasible.

As a chronic condition that affects the central nervous system, MS is an ideal candidate for telemedicine care for several reasons.

• Mobility and accessibility: MS often affects mobility, making travel to in-person appointments challenging. Telemedicine allows patients to receive care from the comfort of their own homes, reducing the physical and emotional stress associated with travel.
• Staying on top of sudden changes (flare-ups/remission): MS is characterized by unpredictable flare-ups and periods of remission. With telemedicine, patients can easily communicate with their healthcare provider about sudden changes in symptoms, leading to quicker adjustments in treatment plans.
• Consistent monitoring: MS requires regular monitoring to assess disease progression. Telemedicine allows for consistent, remote monitoring of symptoms, reducing the need for frequent in-person visits. This can be particularly beneficial for patients living in rural or remote areas who may not have easy access to a neurologist.

Telemedicine care for MS patients can include virtual consultations for discussing symptoms and treatment plans, remote monitoring of symptoms, and digital tools and assessments for tracking and managing symptoms. This approach enables patients to have more control over their healthcare and improves the continuity of care, ultimately leading to better health outcomes.

Teleneurology is employed in MS monitoring for remote assessment of disability, daily symptom tracking, and virtual consultations with neurologists. It enables patients to access specialists and receive care without the requirement for in-person visits.

Moreover, teleneurology facilitates continuous monitoring of disease progression and the implementation of self-directed exercise programs. By leveraging the power of telemedicine, MS patients can receive more personalized and accessible care, ultimately improving their quality of life.

The Benefits of Virtual Visits for Neurology Patients

A teleneurology program offers numerous benefits for neurology patients, including:

• Convenience and travel times: Telemedicine visits can be more convenient for patients who may have difficulty taking time off work or arranging transportation to appointments or who face long travel times
• Improving access to care: Telemedicine can provide neurological expertise to rural areas with limited availability of neurologists and improve care for patients who may have difficulty traveling to appointments
• More frequent checkups: Telemedicine can make it easier for patients to have more frequent checkups with their neurologist, which can help with disease management and monitoring
• Reduced exposure to infectious diseases: Telemedicine can reduce the risk of exposure to infectious diseases, which can be especially important during pandemics like COVID-19
• Comfort: The ability to receive care from the comfort of their own homes may cause patients less stress and anxiety than in clinical settings.

For patients with mobility issues or memory loss, virtual visits provide an effective means of communicating symptoms to a neurologist without the need to travel or the added stress of clinical environments.

However, it's important to underscore that virtual visits, including video consultations, may not be the perfect fit for all medical concerns treated in your neurology department. For instance, certain complex neurological conditions may require a more hands-on approach for accurate diagnosis and effective treatment.

Therefore, while telemedicine has proven beneficial in many cases, its suitability is determined on a case-by-case basis, depending on the specific health issue at hand and the individual patient's needs. New symptoms or other conditions apart from memory loss, including falls, tremors, and vision changes, may not be amenable to virtual visits.

Nonetheless, the overall benefits of virtual visits for neurology patients are undeniable, making them a key component of modern neurological care.

Challenges and Limitations of Telemedicine in Neurology

Despite these advantages, telemedicine in neurology also carries certain challenges and limitations:

Practice Challenges

• Integrating telemedicine and telemetry into clinical practice
• Limitations in performing a comprehensive neurologic exam
• Concerns about patient privacy, such as security of patient data and potential data breaches

Accessibility

• Technology and digital literacy barriers
• Disparities in access to telehealth, which can be influenced by factors like geographic location, socioeconomic status, and the digital divide
• Logistical and technical challenges in implementing virtual care

Patient Concerns

• Lack of in-person interaction
• Difficulty in assessing nonverbal cues

Addressing these challenges requires ongoing research, development, and investment in technology and training. For example, cognitive assessment platforms are a useful tool to help address the issues around testing limitations in telemedicine (we’ll cover this more in later sections).

As the field of telemedicine in neurology continues to evolve, healthcare providers must stay informed and adapt to the changing landscape in order to provide the highest quality care to their patients.

The Role of Health Systems and Insurers in Supporting Telemedicine Neurology

Health systems and insurers have recognized the value of telemedicine in neurology and are taking proactive measures to facilitate its integration into healthcare delivery. These measures include:

• Integrating telemedicine into their systems
• Issuing guidance
• Broadening services
• Addressing reimbursement issues

As a result, many insurance plans now offer coverage for virtual visits, providing patients with convenient access to health care through an online visit. With this increasing support from health systems and insurers, telemedicine in neurology is becoming more accessible and affordable for patients, enabling them to receive the specialized care they need without the added burden of high costs or logistical barriers.

Does Insurance Cover Neurologist Visits?

Insurance coverage for patient visits, including telemedicine services, varies from plan to plan. However, an increasing number of insurance providers are integrating telemedicine services into their coverage.

“The average cost to see a neurologist without insurance ranges from $50 to $500. The national average in the United States is right around $300.” —Pro Insurance Info

This development is beneficial for your patients, as it allows them to access specialized neurological care without the burden of financial stress. It is advisable for your patients to contact their insurance provider to confirm the extent of their coverage and any associated costs.

The inclusion of telemedicine services in insurance coverage is a clear acknowledgment of the value and efficacy of virtual visits in delivering high-quality patient care. This trend is likely to further drive the adoption of telemedicine in the field of neurology.

Reimbursement for Neurologists in Telemedicine

Reimbursement for neurologists who provide telemedicine services is an important aspect of integrating telehealth into practice. With telemedicine, neurologists can offer their services to a larger patient base, thus potentially increasing their revenue. However, the reimbursement process for telemedicine services can be complex and may vary depending on the insurance provider and the specific telehealth services provided.

Most insurance companies now recognize the value of telemedicine and have policies in place for its reimbursement. However, the rates can differ from in-person visits, and it's important for neurologists to understand these differences to ensure they are adequately compensated for their services.

Medicare and Medicaid, for instance, have expanded their coverage to include telemedicine services, especially in the wake of the COVID-19 pandemic. Private insurance companies are also increasingly covering telemedicine visits, although the specifics can vary from one provider to another.

It's crucial for neurologists to verify the reimbursement policies of each insurance provider they work with to ensure they are fully aware of the compensation they can expect for their telemedicine services. Understanding these policies can help them set competitive rates for their services, negotiate better contracts, and ultimately ensure the financial sustainability of their practice.

Related: How to Bill Using CPT Code 96132 for Neuropsychological Testing in 2022: A Guide for Psychologists and Physicians

Integrating Telemedicine Into Your Neurology Practice

Successful integration of telemedicine into a neurology practice necessitates:

• Analyzing current workflows
• Determining the right telemedicine platform
• Exploring cognitive assessment platforms that can be used with telemedicine
• Ensuring HIPAA compliance
• Training staff to use technology
• Communicating with patients
• Setting up protocols for telemedicine visits
• Ensuring the availability of necessary equipment and infrastructure
• Consistently evaluating and refining telemedicine processes.

“OCR [Office for Civil Rights] expects health care providers will ordinarily conduct telehealth in private settings, such as a doctor in a clinic or office connecting to a patient who is at home or at another clinic. Providers should always use private locations and patients should not receive telehealth services in public or semi-public settings, absent patient consent or exigent circumstances.

If telehealth cannot be provided in a private setting, covered health care providers should continue to implement reasonable HIPAA safeguards to limit incidental uses or disclosures of protected health information (PHI).”

—HIPAA and Telehealth, US Department of Health and Human Services

However, it doesn’t need to be excessively complex either: According to Jaime Hatcher-Martin, MD, PhD, Assistant Professor of Neurology at Emory University School of Medicine in Atlanta, “Some use freely available software. Others use software that is either inexpensive or - as in my case - they use something their institution already had a license to use.”

“I started out testing the software with family members and then with some patients that I trusted,” she says. “You can even try comparing a telemedicine exam with an in-person exam (i.e., have the patient in another room and do the virtual exam first, then verify your findings with an in-person exam).” Telemedicine in Your Neurology Practice? Neurology Live, Karen Appold (2017)

Patient Perspectives on Telemedicine Neurology

Patients have generally expressed positive views toward telemedicine neurology, finding it to be a convenient and effective way to receive healthcare support. A systematic review of telemedicine during the COVID-19 pandemic found that most patients (97.6%) were satisfied with their telehealth experience.

Many patients appreciate the flexibility and ability to access neurology care from home, particularly those with physical or financial constraints. Telemedicine can also offer a more personalized experience, as patients can interact with their neurologist in real time. Better patient experience of care is also associated with greater compliance with clinician recommendations, adherence to recommended therapies, and fewer missed follow-up visits.

Although some patients still prefer in-person visits for certain aspects of their care, telemedicine has been well-received by patients in the neurology field. As telemedicine technology continues to advance and become more widely accepted, patient satisfaction is likely to increase, further solidifying its place in modern neurological care.

The Future of Telemedicine in Neurology

The future of telemedicine in neurology is promising, with ongoing advancements in technology and increased acceptance by both patients and healthcare providers driving further growth and innovation in the field.

Technologies such as artificial intelligence, machine learning, and virtual reality are encouraging growth and development in the teleneurology sector. For example, AI is being used to assist telestroke care by providing more rapid and reliable diagnosis through imaging analysis, as well as predicting hospital course and 3-month prognosis.

Healthcare providers need to stay updated and adapt to the changing landscape to ensure they deliver the best care to their patients. By embracing telemedicine and leveraging its benefits, the field of neurology can continue to innovate and improve patient outcomes.

With its numerous benefits, such as convenience, accessibility, and quality of care, telemedicine has already transformed neurological care and will continue to do so in the years to come. As technology advances and healthcare providers continue to adopt telemedicine, the future of neurology is undoubtedly bright, offering patients the opportunity to receive the best possible care, no matter where they are.