Using Telehealth to Provide Subspecialty MS Care to Traditionally Underserved Patients

Background: Previous research has suggested an increasing shortage of neurologists. This is a problem because multiple sclerosis (MS) patients receiving care from neurologists are more likely to receive and use disease-modifying therapies (DMT), participate in rehabilitation clinics, and receive care from rehabilitation specialists. The problem of lack of access may be particularly challenging to MS patients who are traditionally underserved, such as those living in rural areas and African Americans and Latinos. We have previously presented data showing that safety net clinics (Federally Qualified Health Care Centers or FQHCs) provide a useful and cost-effective mechanism for providing care to these traditionally underserved populations. One limitation to providing care through FQHCs is that many MS experts may be geographically remote from these centers.

Objectives: To use technology to provide geographically remote subspecialty MS care to patients with MS who receive care at a safety net clinic (Federally Qualified Health Center).

Methods: Recent laws in Colorado and in other states have created a financial model to provide remote care using audio and video technology ("telehealth"). We have successfully employed telehealth visits as a means for further improving access to neurological care to these traditionally underserved populations. Using specialized audio and visual equipment (at a cost of about $10,000), we have provided remote MS subspecialty care from a major academic center (the Rocky Mountain MS Center at Anschutz Medical Center) to a large FQHC (Metro Community Provider Network). After FQHC clinicians obtained vitals, the supervising neurologist, who had reviewed patients' MRIs and chart summarys via a secure connection, directed and observed the neurological examination as performed by the onsite physician assistant. The supervising neurologist's note was then securely transmitted to the FQHC's EMR; the labs remotely ordered by neurologist were obtained onsite at the FQHC.

Results: The quality of the encounters was perceived to be equivalent to face-to-face encounters by the patients, patient caregivers, the on-site clinician and the offsite neurologist. In particular, the ability to evaluate the MRI results and neurological examination was assessed by the neurologist to be similar to a face-to-face encounter. The encounter was billed through Medicaid at a rate equivalent to a face-to-face encounter.

Conclusions: Apart from the expenses of purchasing specialized equipment, technical hurdles to providing remote MS subspecialty care are minimal. What is critical is that payor systems continue expand to allow for remote treatment. In the future, less expensive equipment should be evaluated as well. Ultimately, telehealth visits have the capacity to expand access to specialty care and improve outcomes, especially to traditionally underserved patients.