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

The Model

Net Medical Express Solutions (NMXS) has developed this telehealth technology to facilitate comprehensive consultation services to hospitals at no upfront cost to the hospitals. Instead the hospitals will pay a per consultation fee to a specialist for assessment and plan-of-care decision-making. The innovation in the ACCESS payment model is that, after funding ends, hospitals will reimburse the neuro-emergent disorder consultation fee on a per encounter basis. In a current program for rural stroke care, 11 hospitals pay approximately $600 per consult with a UNMH neurologist. $300 goes to NMXS to cover overhead, maintenance, support and profit; the other $300 reimburses the neurologist’s time and assessment. The telehealth consultation allows local hospitals to keep their patients, rather than transporting them to UNMH, so the reimbursement from insurance goes to the local hospital. ACCESS will provide rapid access to a high level of expert care, which we anticipate will reduce cost of care while improving quality of care with same or better health outcomes.

ACCESS will enable HCPs to treat most patients with neurological, and non-operative neurosurgical disorders locally when indicated instead of transporting them to UNMH. Local telehealth clinics will provide local follow-up. Audiovisual capabilities will allow neurologists and neurosurgeons at UNMH to review radiographic images and consult with referring HCPs and their patients virtually to deliver enhanced treatment advice. HCPs can also generate a written report within minutes. The teams at UNMH have expertise in all aspects of neurosurgical and neurological emergency care and will be available 24/7. Patients who necessitate tertiary-level intervention will be stabilized and optimized for transport to UNMH. Patients who do not require truly emergent care will be triaged to rural hospitals and referred to appropriate clinics for follow-up care.

One goal of ACCESS is to expand the local expertise in dealing with this broad range of disorders so that fewer patients will need to travel long distances for consultative follow up. This service will be provided at no cost to 30 hospitals for the first three years. After three years, the local hospitals will pay the consultation fee out of funds generated from caring for neuro-emergent patients locally.

Telehealth-enhanced neurosurgical consultation is routinely used in Europe. For example, Fabbri et al.(13) showed that observation in a neurosurgical unit or in a peripheral hospital after telehealth-enhanced neurosurgical phone consultation is safe and does not result in worse outcomes. In one of our studies by Moya et al.,(10) we showed that telehealth-enhanced consultations in New Mexico resulted in care management recommendations or avoided transports in 50% of cases. We saw similar results with our teleradiology program at the Gallup Indian Med. Ctr. (GIMC) where 45% of transfers could be avoided.(9, 14) Implementing this telehealth system in New Mexico will improve efficiency by achieving wider access to effective neuro-emergent care, reducing health care costs through appropriate resource management, and improving quality of care at the referral center due to timely expert consultation.