ACCESS

Access

The Model

The project described is supported by Grant Number 1C1CMS331351-01-00 from the Department of Health and Human Services, Centers for Medicare & Medicaid Services. The contents of this document are solely the responsibility of the authors and do not necessarily represent the official views of the U.S. Department of Health and Human Services or any of its agencies

Expectations

The potential for expanding ACCESS is great. Underserved areas in the U.S. have similar challenges to provide appropriate specialty care, and our model can be easily adapted. Once the infrastructure for emergent consultations is in place, there should be no barrier to expanding consultative services to a broad range of clinical programs such as trauma surgery, orthopedic emergency, etc.

Because NMXS' technology and telecommunication system for connecting neurosurgical providers to patients in local hospitals is uniquely inexpensive and user friendly, this is the optimal solution for the national need to bring specialist care to rural America.

Our experience shows us that ACCESS will provide timely access to neuro-emergent care and prevent unnecessary transfers. In fact, 45% of proposed transfers have been avoided with the integration of teleradiology alone.(9) This telehealth platform will enable the consulting physician to review imaging and—for the first time in trauma management—talk with and examine the patient and generate reports on the spot. This platform will be used at bedside to examine and assess patients, which we anticipate will increase the confidence and decision-making capacity of local and tertiary care physicians. We anticipate this level of communication will also increase patients’, caregivers’, and family members’ confidence that decisions for their loved ones were optimal.

Our proposed telehealth infrastructure will have a major impact on how cerebral emergencies are treated by avoiding unnecessary transfers and admission to neurocritical care units.(10) This not only will save considerable transport and inpatient costs, but also improve access to neuro-emergent care when time is critical and improve patients' satisfaction with their care. This will help us achieve the three overarching CMS goals, to achieve better health, and better health care with a proposed cost savings of $20,738,322.

ACCESS will be instrumental in overcoming health disparities in underserved areas of NM because patients in rural areas are often unnecessarily-triaged to referral centers, creating a financial burden to the health care system and to patients and their families who often have to travel as much as four hours to be with their loved ones. Furthermore, the disparity in outcome among rural patients is not overcome with the current treatment paradigm. With ACCESS, all New Mexico hospitals will have immediate access to specialty care, which will shorten the time to neurological/ neurosurgical consultations, accelerate triage for operative cases, and help with management of patients who do not require emergent care. Overall, we anticipate that ACCESS will improve health and health care satisfaction for patients and their families.

The ACCESS program will also provide a unique learning opportunity for health care professionals and patients alike. We will focus on increasing providers' comfort levels in caring for patients who do not require emergent surgical intervention. This training will be delivered via in-person lectures, hands-on training sessions, mini-internships in the tertiary referral center, web-based refresher courses, social media communities, quarterly webinars, and an annual telehealth conference.