HHS Urged to Adopt New Mexico’s Telestroke Reimbursement Program

Over the last five years, several telestroke programs have flourished around the country, but only one has successfully garnered Medicaid coverage: New Mexico’s Access to Critical Cerebral Emergency Support Services (ACCESS) model. Now, in a bid for telestroke reimbursement, an advisory committee is suggesting that the Department of Health and Human Services (HHS) use the ACCESS program as a model for building a nationwide telestroke network backed by Medicare.

In a recent Twitter post, the Physician-Focused Payment Model Technical Advisory Committee (PTAC) particularly recommended the ACCESS model for rural emergencies. Ultimately, the committee hopes to designate the telemedicine program as a Physician-Focused Payment Model (PFPM), which would allow providers to be reimbursed through Medicare. Currently, ACCESS functions as a statewide alternative payment model (APM) that only charges fees when consulting services are requested by rural or underserved hospitals, generally in emergency situations. By bringing the specialist into the emergency or intensive care room virtually, this model—including telestroke reimbursement—reduces the need for transport to a tertiary care center for evaluation while providing the patient with immediate care in a time-sensitive situation.

The ACCESS program was developed five years ago by the University of New Mexico Health Sciences Center with a grant from the Centers for Medicare & Medicaid Innovation. Set up as a hub-and-spoke telemedicine model, ACCESS was designed to connect rural and remote healthcare providers to neurological specialists instantly in real-time consultations. Thus, the specialists are able to help evaluate, diagnose, and treat patients who display signs of a stroke or other neurological issue, such as traumatic brain injury. As explained by Howard Yonas, MD, professor and chairman of the UNM School of Medicine Department of Neurosurgery, the model has positively impacted patient outcomes, care delivery, and healthcare costs by providing the spoke hospitals with access to the specialists; the hospitals’ low patient volumes for neurology make it financially unviable to keep neurologists on staff.

Yonas isn’t alone in his support; several health system executives and New Mexico legislators, as well as Jeff Bourgeois, president and CEO of San Juan Regional Medical Center, also endorse the concept of expanding the ACCESS program to a nationwide level. In addition to lowering costs, said Bourgeois, giving rural physicians a more active role in transforming the care delivery paradigm will attract more doctors to the rural setting where they can experience higher satisfaction from improved patient outcomes.

Here at swyMed, we’re already working to improve telestroke capabilities. In partnership with Life Image, the world’s largest global network for sharing clinical and imaging data, we will soon be able to integrate clinical and imaging data into the telestroke consultation so that physicians can make well-informed decisions, collaborate, and coordinate patient care more easily.

To learn more about the PTAC’s recommendation and the ACCESS program, visit mHealth Intelligence here.