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Medicare to Reimburse for Telestroke Regardless of Location

Analysis  |  By Alexandra Wilson Pecci  
   February 20, 2018

The FAST Act changes Medicare rules to expand telestroke reimbursement to urban and suburban hospitals.

Incorporated within the bipartisan budget deal signed into law earlier this month is the FAST (Furthering Access to Stroke Telemedicine) Act, which expands telemedicine for stroke by requiring Medicare to reimburse for telestroke services regardless of where a patient receives treatment.

Telemedicine adoption has been inconsistent throughout the United States for several reasons, including how providers would get reimbursed for such services, limitations about which services can be reimbursed for telehealth, and restrictions on where patients can receive the telehealth treatments.

For example, Medicare covers certain services performed at certain locations, while state regulations vary for Medicaid payments, with some states only covering certain services performed by certain types of specialists.

But there seems to be a general consensus about the efficacy of telemedicine in stroke care, and the passage of the FAST Act—which singles out payments for telestroke—helps to confirm that.

As the saying goes, "time is brain" when it comes to stroke evaluation and treatment, says Brett M. Kissela, MD, MS, a Fellow of the American Academy of Neurology.

"Getting to the patient quickly and doing an evaluation is crucial. When people are far from expertise, telemedicine is a useful tool to expedite the evaluation," he says.

Stroke guidelines outline exacting time goals for doing things such as administering tPA (tissue plasminogen activator) medication within 3 to 4.5 hours, depending on the patient, and interpreting CT scans within 45 minutes of ED arrival.

If a hospital doesn't have a stroke specialist on-site, such goals are harder to meet.

"If we can do telemedicine, of course, we can be there in seconds," Kissela says.

Expanding reimbursement

The FAST Act changes Medicare rules to expand telestroke reimbursement to urban and suburban hospitals, instead of only to rural hospitals, allowing telestroke services "even locally ... even if the hospital is two miles away," Kissela says.

"It's going to allow payments for telemedicine consultation for stroke even in highly populated areas," says Kissela, resulting in faster decision-making, faster treatment, and better outcomes.

There's also a strong financial impetus for producing more efficient stroke care.

According to the CDC, stroke costs the United States about $34 billion a year, including the cost of healthcare services, medicines to treat stroke, and missed work days. Annually, more than 795,000 people in the United States have a stroke.

The CDC also says that stroke is a leading cause of serious long-term disability, and that stroke reduces mobility in more than half of stroke survivors age 65 and over.

"You can imagine the immense cost that comes from that," Kissela says.

Related: Telehealth Is More Disruptive Than We May Think

Numerous studies have shown that telestroke services can improve outcomes, including one at Kaiser Permanente's EDs in Northern California.

Meanwhile, though, individual states are still grappling with telemedicine reimbursement in general, such as Missouri, where its House of Representatives is discussing looser telemedicine rules.

The FAST Act will be implemented in 2021.

Alexandra Wilson Pecci is an editor for HealthLeaders.

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