Value

Oral Presentation

(V11-01) Evidence of Sustainability for a Neuro-emergent Telemedicine Consultation Service in a Large Rural State

Tuesday, April 25
12:45 PM - 1:04 PM
Location: W230 BC

Objectives
The Access to Critical Cerebral Emergency Support Services (ACCESS) program, located at the University of New Mexico Hospital (UNMH) system, is designed to provide timely access to neuro-emergent care and prevent unnecessary transfer of patients who will arrive at rural emergency rooms for care. ACCESS builds and expands existing partnerships in a comprehensive neurology and neuro-emergent telehealth network to provide critical state-of-the-art telehealth services to ER providers and their patients. The study pays for the consultations for CMS beneficiaries (Medicare, Medicaid), while hospitals must pay for patients who are commercially insured, self-pay or other insured through other payers.
Outcome Objectives. The purpose of this study is to evaluate the potential sustainability of the New Mexico ACCESS program after the initial funding is complete. Evidence for sustainability is derived from the consultations in which rural hospitals reimburse the ACCESS program and the evaluation of types of consultations and disposition of patients.


Methods
Study Design. Prospective trial of use of telemedicine consultations under two funding mechanisms
Year(s)/Month(s) Study Conducted. May 2015 through August 2016
Disease/Condition Studied. All neurological and neurosurgical emergent encounters
Subjects Studied. Patients admitted to rural emergency departments
Setting in Which Subjects Studied. Rural emergency departments
Intervention(s). Neuro-emergent telemedicine consultations in rural emergency departments
Outcome Measurement(s). Utilization telemedicine consultation, patient disposition
Independent Variables. Payment mechanism, patient and facility characteristics
Preliminary Analyses (Analysis of Ongoing Study). The study evaluated the emergent encounters of all neuro-emergent encounters that used the ACCESS telemedicine consultation service. Patient characteristics and encounter outcomes were separated based on whether the consultation was reimbursed through the grant funds or directly from the rural hospitals.


Results
Of the first 771 consultations for neuro-emergent emergency services, 171 (22.2%) were directly funded through rural hospitals. For all consultations, 59.5% were admitted to the local hospital versus 48.0% for hospital funded encounters; 2.5% were admitted and then later transferred to another hospital versus 3.5% for the hospital funded. An equal percent of patients (10.5%) from the program funded and hospital reimbursed arms were transferred to another facility from the emergency department. Largely due to the inclusion of Medicare, the grant funded encounters had older patients (64 years old vs. 51 years old; p < 0.01) and a lower percentage of female patients (54.5% vs 59.1%; p < 0.05).

Conclusion
The willingness of rural hospitals to use and reimburse telemedicine consultations for neuro-emergent care provides evidence of a self-sustainable funding model for this type of care. The telemedicine program improves the care to patients and is incentive compatible for rural hospitals. The ACCESS is potentially a replicable and scalable model of care for rural states and other emergent conditions.

Maurice L. Moffett

Research Assistant Professor
University of New Mexico Health Sciences Center

Maurice "Mark" Moffett is a Research Assistant Professor in the Department of Family and Community Medicine in the Office for Community Health. Dr. Moffett earned his PhD in Economics at the University of New Mexico and received postdoctoral training in Health Services Research (HSR) through the VA HSR&D and the Baylor College of Medicine. His expertise include economic evaluation, outcomes research, comparative effectiveness and health workforce analysis.

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Elizabeth Muller

ACCESS/Telemedicine Clinical Coordinator
University of New Mexico Department of Neurosurgery

Elizabeth Muller is a registered nurse in the Department of Neurosurgery at the University of New Mexico.

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Andrew L. Hollander

Senior Program Manager
University of New Mexico - Department of Neurosurgery

Trained as an academic biologist and a certified Project Management Professional (PMP). Worked as an administrator at University of Notre Dame in a number of positions over 12 years primarily involved with IT projects, as well as gaining a MBA during that time. Spent 14 years as a Senior Project Manager with a company implementing large Enterprise Resource Planning systems at colleges and universities. Retired for 2.5 years before being coaxed into being the project manager for the University of New Mexico Health Sciences Center Department of Neurosurgery ACCESS (Access to Critical Cerebral Emergency Support Services) Program, which was designed to develop and deliver a sustainable operation for providing neuro-emergent telemedicine consultations to Emergency Departments throughout the state of New Mexico.

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Howard Yonas

Professor and Chair
University of New Mexico Department of Neurosurgery

Dr. Yonas obtained his medical degree from Ohio State University. He completed internship and residency in Neurosurgery at Case Western Reserve University. As the director of the new UNM Cerebrovascular Center, Dr. Yonas is working to build a strong interdisciplinary stroke team which will focus an innovative combination of invasive and non-invasive technologies designed to improve stroke and trauma care.

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Colin Semper

Administrator
University of New Mexico Department of Neurosurgery

Colin Semper is the Administrator of the Department of Neurosurgery at the University of New Mexico.

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(V11-01) Evidence of Sustainability for a Neuro-emergent Telemedicine Consultation Service in a Large Rural State



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