HHS Urged to Make New Mexico’s Telestroke Program a National Model – mHealthIntelligence.com

September 18, 2019 -An advisory committee is urging the Department of Health and Human Services to take a closer look at New Mexicos statewide telestroke network, with the goal of turning the telemedicine program into a national model for Medicare.

The Physician-Focused Payment Model Technical Advisory Committee (PTAC) recommended this week that the HHS Secretary further develop and implement the ACCESS telemedicine model for rural cerebral emergencies, according to the agencys Twitter post. The goal is to designate the telehealth program as a Physician-Focused Payment Model (PFPM), giving providers an opportunity to be reimbursed through Medicare.

Developed roughly five years ago by the University of New Mexico Health Sciences Center with a Centers for Medicare & Medicaid Innovation (CMMI) award, the Access to Critical Cerebral Emergency Support Services (ACCESS) program uses a hub-and-spoke telemedicine model to give rural and remote healthcare providers on-demand, real-time access to neurological specialists. The virtual care link enables those specialists to help diagnose and treat patients showing signs of a stroke or some other neurological issue, such as a traumatic brain injury.

Critical care and rapid decision making for emergency cerebral conditions are imperative and time-sensitive to maximize patient outcomes in these populations, Howard Yonas, MD, a professor and chairman of the UNM School of Medicine Department of Neurosurgery, wrote in his report to PTAC. Rural and underserved community hospitals cannot employ full time neuro specialists. In the current care model, emergency room physicians are often ill prepared to diagnose and treat these patients. As a result, most patients with this spectrum of disorders are transferred to a tertiary care facility for further evaluation and treatment. This current model driven by geographic healthcare disparity negatively impacts patient outcomes driven by timely treatments, healthcare economics, and care delivery experience.

While similar to several telestroke programs across the country, New Mexicos ACCESS platform includes one important distinction: Medicaid coverage.

According to Yonas, the program saw clinical success in its four years of operation but couldnt gain enough reimbursement from public or private payers to ensure scalability. Organizers then decided to work with the states Medicaid and Managed Care organizations to create a bundled payment program. That model was included in the New Mexico Medicaid programs physician fee schedule at the beginning of 2019.

An innovative, alternative payment model (APM) that only charges for consulting services when needed is ideal for rural hospitals that may only have an emergent need a few times per week/month, Yonas wrote. As demonstrated in our ongoing model deployment in the NM ACCESS program, these consulting services can be effectively provided remotely through telemedicine. Cloud based technology has removed the need for geographic proximity and increased the pool of specialists that can rapidly provide neuro emergent care and triage. All stakeholders effectively engaged with the technology to maximize patient care and reduce costs, and all provided high levels of user satisfaction with the technology and program model. While our model initially focused on small, rural spoke hospitals, we quickly discovered that the model also applied to hospitals that were not typically classified as rural, but similarly experience shortages of neurological specialists.

Yonas report to PTAC included letters of support from several New Mexico legislators and health system executives.

As a site for the ACCESS program, we have seen first-hand how the model is perfect for rural and underserved hospitals, wrote Jeff Bourgeois, president and CEO of the San Juan Regional Medical Center. It is episode-based, using a per consult fee based on specialty fair market value to provide emergent specialty care. The model is built on affordable, state of the art technology which brings a specialist into an emergency or intensive care room when time is of the essence and where many times unnecessary transport occurs because of the lack of physician education and specialist availability/support.

If implemented on a national level, we believe that this healthcare delivery model will provide significant savings to CMS and all other insurance payers, he added. This program provides opportunities for participation in Advanced APMs by providing a specialty care physician to support the physicians at rural hospitals. We believe that by enhancing the ability of rural physicians to participate in transformative delivery system reforms, it will increase their willingness to work in rural setting where they will experience increased satisfaction in providing improved patient outcomes.

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HHS Urged to Make New Mexico's Telestroke Program a National Model - mHealthIntelligence.com