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Special Editorial
April 1, 2020
podcastLetter to the Editor

COVID-19 is catalyzing the adoption of teleneurology

May 26, 2020 issue
94 (21) 903-904

Abstract

The coronavirus disease of 2019, or COVID-19, changed the world within a matter of weeks. The primary action to constrain the spread of the virus is social isolation. Given this public health principle, and the shortage of personal protective equipment during the global pandemic, all health care stakeholders need to reconsider the indications for face-to-face health care encounters in providing patient care. Which encounters are imperative and which ones can be switched to non–face-to-face care? What changes in laws, regulations, payment policies, and workflow are needed to enable this transition?1–3

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References

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Hollander JE, Carr BG. Virtually perfect? Telemedicine for Covid-19. N Engl J Med Epub 2020 March 11.
2.
Lurie N, Carr BG. The role of telehealth in the medical response to disasters. JAMA Intern Med 2018;178:745–746.
3.
American Telemedicine Association. COVID-19 (Coronavirus) News, Information & Resources. Available at: info.americantelemed.org/covid-19-news-resources. Accessed March 24, 2020.
4.
Wechsler LR. Advantages and limitations of teleneurology. JAMA Neurol 2015;72:349–354.
5.
Hatcher-Martin JM, Adams JL, Anderson ER, et al. Telemedicine in neurology: Telemedicine Work Group of the American Academy of Neurology update. Neurology 2020;94:30–38.
6.
American Medical Association. 2020 CPT Professional Edition. Chicago, IL: American Medical Association; 2019.
7.
Guzik AK, Switzer JA. Teleneurology is neurology. Neurology 2020;94:16–17.
8.
HHS Issues Section 1135 Waiver, and CMS Issues Blanket Waivers of Health Care Laws, in Response to Coronavirus (COVID-19) Emergency. Available at: natlawreview.com/article/hhs-issues-section-1135-waiver-and-cms-issues-blanket-waivers-health-care-laws. Accessed March 21, 2020.
9.
Center for Connected Health Policy. Telehealth Coverage Policies in the Time of COVID-19. Available at: cchpca.org/resources/covid-19-telehealth-coverage-policies. Accessed March 21, 2020.
10.
Lacktman NM, Acosta JN, Levine SJ. 50-State Survey of Telehealth Commercial Payer Statutes. Foley.com/Telemedicine, December 2019. Available at: foley.com/-/media/files/insights/health-care-law-today/19mc21486-50state-survey-of-telehealth-commercial.pdf. Accessed March 21, 2020.
11.
American Academy of Neurology. AAN Telemedicine and Remote Care Website. Available at: aan.com/telehealth. Accessed March 21, 2020.
13.
Duffy S, Lee TH. In-person health care as option B. N Engl J Med 2018;378:104–106.
14.
National Consortium of Telehealth Resource Centers. NCTRC Webinar – Telemedicine: How to do it Right! 2019. Available at: telehealthresourcecenter.org/events/category/webinars/list/?tribe_event_display=past&tribe_paged=2: the future of neurological care. Accessed March 25, 2020.
Letters to the Editor
21 April 2020
Author response: COVID-19 is catalyzing the adoption of teleneurology
Brad C. Klein, Neurologist | Abington Hospital, Department of Neurology, Thomas Jefferson University
Neil A. Busis, Neurologist | NYU Langone Health, Department of Neurology

We thank Dr. Sethi for his thoughtful comments on our editorial1 and on new rules, regulations and policies that encourage the use of telehealth during the COVID-19 pandemic and complexities of telehealth reimbursement.2 Although telehealth increases access to care and has a growing evidence base,3,4 the primary driver for rapid deployment during the COVID-19 pandemic is ensuring safety by social distancing.

The current reimbursement system for telehealth consists of modifications of pre-existing codes designed to lower the barriers to virtual encounters. Most of the recommended codes were designed for face-to-face evaluation and management (E/M) services and can now also be used for virtual encounters with the proper modifiers.2,5 Other codes were always designed to be non-face-to-face codes, such as the telephone E/M codes.2,5 They have built in restrictions aimed at preserving the primacy of face-to-face services, which have not been rescinded.2,5

The COVID-19 pandemic has forced patients, providers, policymakers, and payers to rethink how health care should be delivered. Since telehealth is effective in a range of clinical situations, we hope the current favorable environment for telehealth will not change substantially after the COVID-19 pandemic is controlled.1,3,4 We further hope that future reimbursement systems will be streamlined and more clinically meaningful.1,2

Disclosure

The author reports no relevant disclosures. Contact [email protected] for full disclosures.

References

  1. Klein BC, Busis NA. COVID-19 is catalyzing the adoption of teleneurology. Neurology 2020 Epub Apr 1.
  2. Cohen BH, Busis NA, Ciccarelli L. Coding in the World of COVID-19: Non–Face-to-Face Evaluation and Management Care. In: Continuum: Lifelong Learning in Neurology. In press 2020 Epub 2020 Mar 27. Available at: https://cdn-links.lww.com/permalink/cont/a/cont_2020_03_26_coding_2020-1.... Accessed April 20, 2020.
  3. Dorsey ER, Glidden AM, Holloway MR, Birbeck GL, Schwamm LH. Teleneurology and mobile technologies: the future of neurological care. Nat Rev Neurol 2018;14:285–297.
  4. Hatcher-Martin JM, Adams JL, Anderson ER et al. Telemedicine in neurology: Telemedicine Work Group of the American Academy of Neurology update. Neurology 2020;94:30–38.
  5. CPT manual: American Medical Association. CPT 2020 Professional Edition. Chicago: American Medical Association; 2019.
14 April 2020
Reader response: COVID-19 is catalyzing the adoption of teleneurology
Nitin K. Sethi, Associate Professor of Neurology | New York-Presbyterian Hospital, Weill Cornell Medical Center (New York City)

I read with interest the editorial on COVID-19 and teleneurology.1 The COVID-19 pandemic has changed the way neurology is practiced in the United States. While physicians were encouraged to practice telehealth through their existing electronic health record (EHR) software, telehealth could be pursed via Zoom, WhatsApp, FaceTime or a telephone encounter. The above measures are a welcome relief to both physicians and patients as it helps maintain continuity of essential medical care during the COVID-19 pandemic. Overnight, it seems new documentation guidelines came out with respect to televisits. We were told that physician documentation should include time start/end, participants on call, and physical location of the patient at the time of the televisit. There had to be documentation of verbal consent that the patient understood that this is a billable visit. Patients could not have a phone visit within 7 days following last evaluation and could not be scheduled for an in-patient visit within 24 hours after a telephone visit. The COVID-19 pandemic is going to change the world as we knew it. When it comes to the practice of medicine, the rules are expected to change, too. While some old barriers have thankfully fallen, unfortunately new barriers have come up.

Disclosure

The author reports no relevant disclosures. Contact [email protected] for full disclosures.

Reference

  1. Klein BC, Busis NA. COVID-19 is catalyzing the adoption of teleneurology. Neurology 2020 Epub Apr 1.

Information & Authors

Information

Published In

Neurology®
Volume 94Number 21May 26, 2020
Pages: 903-904
PubMed: 32238505

Publication History

Published online: April 1, 2020
Published in print: May 26, 2020

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Disclosure

B.C. Klein has received honoraria for speaking at American Academy of Neurology courses and serves on the speaker's bureau of Allergan, Amgen, Biohaven, Eli Lilly, Teva, US WorldMeds, and West Lundbeck. He has served as consultant for Allergan, Amgen, Promius, and Biohaven. He has received commercial research support from Alder, Allergan, and Eli Lilly. Dr. Klein has equity interest in Abington Neurological Associates, Ltd. and AppsByDocs, LLC. B.C. Klein is a member of the American Academy of Neurology Board of Directors. N.A. Busis receives honoraria for speaking at American Academy of Neurology courses and for serving as Alternate CPT Advisor for American Academy of Neurology and is a former member of the American Academy of Neurology Board of Directors. Go to Neurology.org/N for full disclosures.

Study Funding

No targeted funding reported.

Authors

Affiliations & Disclosures

Brad C. Klein, MD, MBA
From Abington Hospital (B.C.K.), Department of Neurology, Thomas Jefferson University, Philadelphia, PA; and Department of Neurology (N.A.B.), NYU Langone Health, New York.
Disclosure
Scientific Advisory Boards:
1.
NONE
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
(1) Allergan, (2) Amgen, (3) Biohaven, (4) Eagalet, (5) Eli Lilly, (6) Lundbeck, (7) Promius, (8) Teva, (9) US WorldMeds.
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
Abington Neurological Associates, Ltd., Chief Operating Officer, 12 years
Consultancies:
1.
(1) Allergan, (2) Amgen, (3) Biohaven, and (4) Promius
Speakers' Bureaus:
1.
(1) Allergan, (2) Amgen, (3) Biohaven, (4) Eagalet, (5) Eli Lilly, (6) Lundbeck, (7) Promius, (8) Teva, (9) US WorldMeds.
Other Activities:
1.
Equity interest in AppsByDocs, LLC, makers of p-cog.
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
(1) Alder, (2) Allergan, and (3) Eli Lilly
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE
From Abington Hospital (B.C.K.), Department of Neurology, Thomas Jefferson University, Philadelphia, PA; and Department of Neurology (N.A.B.), NYU Langone Health, New York.
Disclosure
Scientific Advisory Boards:
1.
Alternate CPT Advisor for American Academy of Neurology on the CPT Advisory Committee. CPT is operated by the American Medical Association
Gifts:
1.
NONE
Funding for Travel or Speaker Honoraria:
1.
Speaker at courses sponsored by the American Academy of Neurology
Editorial Boards:
1.
NONE
Patents:
1.
NONE
Publishing Royalties:
1.
NONE
Employment, Commercial Entity:
1.
NONE
Consultancies:
1.
NONE
Speakers' Bureaus:
1.
NONE
Other Activities:
1.
Former Member of the American Academy of Neurology Board of Directors. Only travel expenses until April, 2017 were reimbursed.
Clinical Procedures or Imaging Studies:
1.
NONE
Research Support, Commercial Entities:
1.
NONE
Research Support, Government Entities:
1.
NONE
Research Support, Academic Entities:
1.
NONE
Research Support, Foundations and Societies:
1.
NONE
Stock/stock Options/board of Directors Compensation:
1.
NONE
License Fee Payments, Technology or Inventions:
1.
NONE
Royalty Payments, Technology or Inventions:
1.
NONE
Stock/stock Options, Research Sponsor:
1.
NONE
Stock/stock Options, Medical Equipment & Materials:
1.
NONE
Legal Proceedings:
1.
NONE

Notes

Correspondence Dr. Klein [email protected]
Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the editorial.

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