- Congress is set to revisit a bill that would expand Medicare reimbursement nationwide for telestroke services.
The Furthering Access to Stroke Telemedicine (FAST) Act, originally introduced in 2015, would alter the Social Security Act to allow Medicare coverage of telestroke services no matter where the patient is located. Current legislation allows those services only in certain rural areas.
U.S. Reps. Morgan Griffith (R-Va.) and Joyce Beatty (D-Ohio), who co-sponsored the original legislation, made the announcement this week that they have reintroduced the bill, with the support of the American Heart Association and American Academy of Neurology.
Both said they want to apply telemedicine technology that has proven its value in combatting the nation’s fifth leading cause of death.
“The FAST Act, as the name implies, will help more stroke victims gain faster access to high-quality care through remote evaluation and treatment - commonly called telestroke,” Beatty said in a press release. “As a stroke survivor and co-chair of the Congressional Heart and Stroke Coalition, I know firsthand how minutes can literally mean the difference between life and death. That is why I proudly join Congressman Griffith in reintroducing the FAST Act to ensure telestroke is readily available to more people.”
“This critical bill would make a world of difference for stroke survivors facing barriers to telestroke services,” added AHA President Steven Houser, PhD, in the release. “Evidence indicates that telestroke improves patient outcomes and reduces disability. However, nearly 94 percent of the strokes that occur in America take place in areas where telestroke is not paid for by Medicare. We urge Congress to give more Medicare patients access to this proven form of treatment and support the FAST Act.”
There’s no shortage of studies and testimony indicating that telemedicine can save the lives of stroke patients by speeding up the time to clinical intervention – most often, the administration of the clot-busting drug Tissue Plasminogen Activator (tPA) within four hours of a stroke.
In late 2015 the Cleveland Clinic published a study reporting a door-to-CT rate of 13 minutes on average and a door-to-intravenous thrombolysis (IV-tPA administration) rate of 32 minutes on average through the use of a mobile stroke treatment unit. Under normal circumstances, where a patient exhibiting signs of a stroke is rushed to the nearest hospital, those rates average 18 minutes and 58 minutes, respectively.
Last August, Kaiser Permanente released a study showing a 75 percent increase in timely use of tPA following a telemedicine consult.
“These findings have important implications for future delivery of stroke care,” Kaiser Permanente researchers, writing in The Permanente Journal, reported. “Particularly in hospitals with limited local resources and/or limited access to neurologic expertise, telestroke is an important tool to aid in the evaluation and treatment of potential stroke. We specifically found that unwarranted hospital variability in stroke care could be eliminated through a standardized telestroke program. Additionally, telestroke may aid in triage and transfer decisions and in identifying patients potentially eligible for endovascular intervention or patients who might otherwise benefit from transfer to a stroke center.”
Shortly thereafter, the AHA joined with the American Stroke Association to release a scientific statement on quality measures and outcomes for the use of telemedicine in stroke cases, marking the first time that standards had been proposed for the platform.
"Telestroke has evolved over the last decade and is now used quite extensively to take care of acute stroke patients in the U.S. and the rest of the world," Lawrence R. Wechsler, MD, chairman of the AHA/ASA writing committee, said. "Because of this we felt it was time to bring out this statement, which provides a structure against which hospitals can measure the quality of their telestroke programs so patients can be assured of getting the quality they deserve."
Griffith and Beatty’s bill follows by days the resubmission of another piece of telemedicine legislation. Earlier this week, Michigan Sens. Debbie Stabenow and Gary Peters resubmitted the Hallways to Health Act, which aims to boost telehealth services in schools by connecting them with community health centers and create a demonstration project to expend access in underserved areas.
In resubmitting the FAST Act, Griffith recalled how fast action saved the life of Virginia Congressman Bob Bloxom when he suffered a stroke in 2001.
tPA and telestroke ought to be readily available to help improve the chances of recovering from a stroke,” Griffith said.
“Telemedicine has the potential to improve the lives of millions of individuals suffering from chronic conditions.,” added American Academy of Neurology President Terrence L. Cascino, MD, FAAN, in this week’s press release. “Stroke is a condition that needs to be treated immediately in order to minimize damage to the brain. This legislation focuses on expanding access to a proven method for treating strokes quickly.”
“Stroke patients with access to a neurologist have significantly better outcomes than those that do not. Reimbursing for telestroke consultations under Medicare will dramatically increase the number of beneficiaries who have timely access to a neurologist, ultimately producing steep reductions in disability that should save the federal government money.”