- A telehealth program for patients with Parkinson’s disease received high marks from both patients and doctors, according to a paper published this week in Neurology.
Whether such a program can be sustained, researchers say, may depend on whether the federal government changes its reimbursement policies.
Launched by the University of Rochester Medical Center in New York and supported by the Patient-Centered Outcomes Research Institute (PCORI), the study of roughly 200 people with Parkinson’s disease found that 97 percent were satisfied with virtual visits and 55 percent preferred them over in-person visits. More than 85 percent of the neurologists involved in the study also expressed satisfaction with the telehealth platform.
"Over 40 percent of people with Parkinson's disease never receive care from a neurologist, yet studies have shown that people who see a neurologist are less likely to be hospitalized with illnesses related to Parkinson's disease, have greater independence and are less likely to die prematurely," Ray Dorsey, MD, of URMC and a member of the American Academy of Neurology, said in a press release accompanying the study’s publication. "We wanted to see if virtual house calls would be feasible for people with Parkinson's disease."
But under the Centers for Medicare & Medicaid’s guidelines for reimbursing telehealth, Medicare does not reimburse for home-based virtual visits or for any telemedicine services in areas other than federally designated rural zones.
The issue isn’t new. Several studies focusing on different chronic conditions have made mention of CMS’ telemedicine and telehealth coverage restrictions, and several bills now before Congress are taking aim at those limitations.
"Virtual house calls have the potential to dramatically increase access to care for people with such a debilitating disease," David Shprecher, DO, of the Banner Sun Health Research Institute in Sun City, Ariz., and a member of the American Academy of Neurology, said in an editorial accompanying the study. "The 21st Century Cures Act mandated a report on which chronic conditions could be improved most by the expansion of telemedicine. Parkinson's disease should be considered for this report, and it should expand the definition of telemedicine to include the virtual house call."
The study drew from a national pool of patients recruited online by the National Parkinson Foundation, PatientsLikeMe and the Michael J. Fox Foundation for Parkinson's Research. Those involved in the study received as many as four video visits with a neurologist they hadn’t seen before.
Dorsey said those using telehealth saved an average of 169 minutes and 100 hours normally spent on transportation.
URMC officials focused on those metrics when they launched a free telemedicine program this past May for 500 Parkinson’s patients in rural communities around New York. Supported by grants from the Greater Rochester Health Foundation and the Edmond J. Safra Foundation, the Parkinson's Disease Care, New York (PDCNY) program aims to help those who don’t see a apecialist.
"Providing coordinated, ongoing care to Parkinson's patients in the traditional settings of a doctor's office requires these individuals and their caregivers and families to travel, often long distances, and is expensive for payers and patients alike," said program director and URMC neurologist Kevin Biglan. "The PDCNY program will break down the barriers of geography and deliver care directly to patients who have never seen a specialist and in the comfort of their own homes."
"By providing care directly into the homes of individuals with Parkinson's, this program will address barriers to access of care, improve the quality of care these individuals receive and improve their function and quality of life," Biglan added.
Dorsey said that program helps to remove the challenges associated with access – namely, geographic and economic – that keep Parkinson’s patients from getting the care they need. His study, meanwhile, proves that care delivered via telehealth is just as good as in-person treatment.
"People were very interested in taking part in this study, and the results showed that these virtual house calls were feasible for people with Parkinson's disease,” Dorsey said. “People's care was as effective as with the in-office visits, and the virtual house calls provided the participants with convenience and comfort."