Teleneurology to Play Significant Role in COVID-19 Prevention

Judd E. Hollander, MD

This article was originally published on HCPLive, part of the HCPLive Network.

Telemedicine technology has become a growing part of overall health care delivery in the United States, but now there is potential for it to play a major role in responding to the outbreak of COVID-19.

The article was published last week in The New England Journal of Medicine, and was written by Judd E. Hollander, MD, of the Sidney Kimmel Medical College of Thomas Jefferson University, in Philadelphia, and Brendan G. Carr, MD, of the Icahn School of Medicine at Mount Sinai, New York.

Hollander and Carr write that many features of COVID-19 make it relatively easy to screen patients and refer them for testing via telemedicine.

“Respiratory symptoms—which may be early signs of COVID-19—are among the conditions most commonly evaluated with this approach,” they write. “Health care providers can easily obtain detailed travel and exposure histories. Automated screening algorithms can be built into the intake process, and local epidemiologic information can be used to standardize screening and practice patterns across providers.”

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Furthermore, by using telemedicine, providers can avoid risk to themselves or their colleagues.

If the number of available diagnostic tests and testing sites increases, it might be possible to diagnose patients completely without the need for the patient to visit the physician in-person.

The authors note that even if a patient comes into the emergency department, telemedicine can play a role. For instance, a remote physician could conduct screenings of patients with respiratory symptoms using a tablet computer. High-risk patients could then be isolated more quickly. Telemedicine can also be used to connect with specialists, they note.

However, telemedicine could have a role to play to help patients who are not suspected of COVID-19 by converting scheduled office visits to telemedicine visits, thereby eliminating any risk the patient might face if he or she ended up in the waiting room alongside someone with the novel coronavirus.

If telemedicine inherently brings a wide number of benefits to the COVID-19 pandemic, it also comes with 1 major question mark—billing.

“The main barriers to maintaining usual care by telemedicine require changes that are unlikely to come from the federal level,” Hollander and Carr write, noting that commercial reimbursement, Medicaid reimbursement, and credentialing all are handled at the state level, and thus can vary significantly by state. Only 1 in 5 states requires payors to pay the same amount for a telemedicine service as they pay for in-person visits.

One positive sign, say Hollander and Carr, is that both the Centers for Medicare and Medicaid Services and some insurers have decided to alter their payment policies for the COVID-19 outbreak.

“We hope others will follow suit,” they add.

Ultimately, the authors write that while telemedicine is not a panacea, it can facilitate a significant amount of health care provision in a manner that is less taxing on facilities and less dangerous to healthcare workers.

“Though telehealth will not solve them all, it’s well suited for scenarios in which infrastructure remains intact and clinicians are available to see patients,” they conclude.