American Academy of Neurology Lobbies for Telehealth Coverage

The American Academy of Neurology is joining the effort to compel Congress to extend telehealth coverage past the pandemic, saying connected health will continue to be a valuable tool to help people with neurologic conditions.

The AAN issued a 22-page telehealth position statement this week in advance of next week’s annual “Neurology on the Hill” conference in Washington DC. At that event, the organization will meet with lawmakers to press for permanent telehealth policy.

“People with neurologic conditions like Alzheimer’s disease, migraine, multiple sclerosis, Parkinson’s disease, ALS or epilepsy often must visit their neurologist many times a year to monitor the progression of disease and to have medications adjusted,” AAN President Orly Avitzur, MD, MBA, FAAN, said in a press release. “However, this can be challenging due to mobility issues, lack of reliable transportation and cost. The COVID-19 pandemic has led to neurology practices dramatically reshaping the delivery of care for their patients. The American Academy of Neurology is asking members of Congress for a permanent expansion of telehealth services to improve safety and access to care and to reduce health care costs for people with neurologic disease.”

The position statement updates a 2014 document that also called for more telehealth coverage, but adds in a considerable amount of evidence accrued over the last few years – and particularly during the pandemic – that telehealth is benefitting both providers and their patients.

“Prior to the pandemic, telehealth programs were restricted, mostly available only to people in rural areas or a limited number of specified locations who did not otherwise have access to specialized care, or in small pockets of contracted services, often outside of Medicare or other insurance coverage,” Bruce Cohen, MD, FAAN, who chairs the AAN’s Advocacy Committee, said in the release. “Neurologists have been asking for an expansion of telehealth for many years. Now it is clear, telehealth is an essential and effective method of delivering care. This has only been possible due to the policy flexibilities enacted by the federal government, along with the broad interpretation of these provisions by the Centers for Medicare & Medicaid Services, and with cooperation from the states and commercial payers. It is important to neurologists and their patients that after the pandemic, telehealth continues to play an essential role in medical care.”

Just two years ago, the AAN released an analysis of roughly 100 studies that indicated telehealth treatments address some of the barriers to access to patients, including availability of specialists and travel issues, and are considered just as good as in-person care by those patients. But that document also pointed out the lack of studies on the ability of telehealth to make an accurate diagnosis, and urged more research on clinical outcomes.

“We need to conduct further studies to better understand when virtual appointments are a good option for a patient,” senior author Raghav Govindarajan, MD, of the University of Missouri, who served as a chair on the American Academy of Neurology's Telemedicine Work Group and is a Fellow of the American Academy of Neurology, said at that time. “Keep in mind that telemedicine may not eliminate the need for people to meet with a neurologist in person. Rather, it is another tool that can help increase people's access to care and also help lessen the burden of travel and costs for patients, providers and caregivers.”

Now, with COVID-19 providing more evidence and Congress facing pressure from many interested parties to permanently extend telehealth freedoms, the AAN is ramping up its lobbying efforts.

“Telehealth won’t replace all in-person neurologic care, but for people with neurologic conditions, it has been shown to complement it,” Jaime Hatcher-Martin, MD, PhD, of SOC, one of the authors of the position statement, sad in the release. “It is also important that people have options. In addition to video visits, telehealth visits by phone are essential to ensure access to care for people who either cannot afford or who do not have access to high-speed broadband internet.”

“The AAN predicts that telehealth will continue to play an essential role in the care of patients with neurologic conditions,” the document concludes. “We will best serve our patients and our members by advocating for increased access; broader insurance coverage; fair reimbursement; reduced regulatory and legislative barriers; and expanding the telehealth evidence base by promoting research on its proper roles and value in neurologic care and on the costs associated with providing telehealth services.”