A national shortage of neurologists has for years resulted in patients falling through the cracks, especially those with mobility issues or who live in remote areas.
The broadening of telemedicine reimbursement, brought on by the COVID-19 pandemic, has served as a net for many of these previously unseen patients. We spoke to one neurologist, Dr. Elaine Jones, who shared how this is particularly helping neurology patients in one small town in Alaska.
Jones has been practicing telemedicine for years. Well before the coronavirus hit, she was able to see patients remotely from an office she set up in the home she shares with her elderly parents in South Carolina.
“When COVID hit, it was kind of nice that I was already doing telemedicine so I didn’t have to worry about exposure and working in an ER,” Jones told us in a recent interview.
For the last handful of years she has been working for SOC Telemed, serving ERs remotely across the country. Jones ran a private neurology outpatient practice for years before switching to telemedicine as a way of dealing with an all too common problem among neurologists: burnout.
She also loves to travel, and this arrangement has allowed her to do that. To keep her feet wet, get in some travel, and feed her love of in-person care, she picks up locum tenens work when she can.
At the end of 2019, a job like that came up serving a hospital in Soldotna, Alaska, three hours south of Anchorage and with a population a little more than 4,000.
“I’ve always wanted to go to Alaska, so I agreed to do it,” said Jones. “Then when COVID hit, I thought it might not happen because of all the travel restrictions.”
Those travel restrictions were eased and she began the job in May 2020. She sees patients in person for two weeks every month and then does phone calls and televisits from her home in South Carolina the rest of the month.
“The mix of live and tele cases is interesting,” Jones wrote in a July email. “Some patients have to drive one to two hours to be seen here, so offering follow-up visits by tele has been great! Not only convenient for them, but I feel we can check in more easily and make changes to care. I feel I am offering better care and better customer service by using quick tele visits.”
This kind of follow up and continuity of care wouldn’t have been possible before the pandemic and the loosening of telemedicine reimbursement rules.
“Before, you had to have specific diagnoses, and you couldn’t do a lot of outpatient stuff,” she says. “You had to use G codes or the specific telemedicine codes. Now you can bill E&M codes, even if it is done via telemedicine. It is really suited to an outpatient practice and the volume of business that could be done by telemedicine is just huge … and appropriate.”
The issue now, she told us, is What is going to happen going forward? What happens after the pandemic is over?
“We can’t go back to where we were pre-COVID because there is such a benefit to telemedicine,” Jones says. “I am worried it’s going to switch back, and it will switch back if it’s not paid for.”
For this reason, Jones has been working with the American Academy of Neurology (AAN) in their work with regulators, CMS, and other payers to maintain at least some of the telemedicine gains made since the pandemic started. She is part of a large committee that reviews “some of the regulations that are coming out from CMS and provide feedback on that.”
“We are reaching out to private payers to to say, ‘Hey, what are you going to do when this ends?’ she adds. “Let’s come up with a rational approach. It’s not appropriate to do everything by telemedicine. But it improves access for many patients who may have limited mobility or difficulty getting in or may be very rural or far away from their doctor.”
Like her patients in Soldotna.
For them and the many patients who have actually gained access to neurology care during this pandemic, “we must keep the tele options viable for practices,” she says. “If we really want to make health care patient-centered this is a no brainer.”