The future of health care is moving towards providing safe, quality care via telemedicine; however, the patchwork of state-by-state medical licensing rules inhibit the delivery of medical services through telemedicine. Patients should not have to take a road trip to access Mayo Clinic’s medical expertise and knowledge. “Cross-border licensure is a strategic imperative as we move forward in this brave new world,” said Kathleen Harrington, chair of government relations at Mayo.
Mayo’s vast cadre of subspecialists — who diagnose and treat very rare and complex conditions — should be available to physicians in any location to help them bring safer care, better outcomes, fewer redundancies, and ultimately higher quality and cost savings for their patients. Mayo Clinic provides subspecialty expertise through telemedicine to physicians in its Mayo Clinic Care Network of more than two dozen hospitals and health systems, including Dartmouth-Hitchcock in New Hampshire; NorthShore University HealthSystem in the suburbs of Chicago; Baptist Health Care in Pensacola, Fla.; and ThedaCare in Wisconsin.
In stroke telemedicine, also called telestroke, neurologists remotely evaluate people who have had acute strokes and make diagnoses and treatment recommendations to emergency medicine doctors at other sites. Having a prompt neurological evaluation increases the possibility that a patient may receive clot-dissolving therapies (thrombolytics) or other clot-retrieving procedures in time to reduce disability and death resulting from stroke.
Researchers recently found that telestroke appears to be cost-effective for society, and study findings were published in The American Journal of Managed Care. "This study shows that a hub-and-spoke telestroke network is not only cost-effective from the societal perspective, but it's cost-saving,” says neurologist Bart Demaerschalk, M.D., director of the Mayo Clinic Telestroke Program and the lead investigator of the telestroke cost-effectiveness study. “We can assess medical services, like telemedicine, in terms of the net costs to society for each year of life gained."
The study estimates that compared with no network, a modeled telestroke system consisting of a single hub and seven spoke hospitals may result in the appropriate use of more clot-busting drugs and more catheter-based interventional procedures and other stroke therapies, with more stroke patients discharged home independently. Despite upfront and maintenance expenses, the entire network of hospitals realizes a greater total cost savings.
The improvement in outcomes is associated with reduced resource use (inpatient rehabilitation, nursing homes, caregiver time). Although treating patients in a telestroke network is associated with higher upfront costs due to the setup of the telestroke network and more costly treatments during the initial hospitalizations, it can potentially lead to cost savings over a lifetime. “The results serve to inform government organizations, insurers, health care institutions, practitioners, patients and the general public that an upfront investment in telemedicine and stroke network personnel can be justified in our health system,” Dr. Demaerschalk says.
For more information on telemedicine, please view the videos featured in the following Mayo Clinic YouTube playlist: