Neurology®, telestroke is cost-effective for treating potential stroke patients who go to emergency rooms in rural hospitals that do not have an around-the-clock neurologist on staff.Stroke patients in rural areas can avoid death or disability thanks to an advance in video conference technology, which allows neurologists in distant cities to diagnose the patients promptly and accurately. This video conference technology is known as telestroke. According to a paper published in the September 14, 2011, online issue of
Greg Saltzman, a professor of economics and management at Albion College who has also taught at the University of Michigan School of Public Health, was one of five authors of the paper on the cost-effectiveness of telestroke. Saltzman said that previous studies showed that telestroke could improve clinical outcomes. The study he co-authored showed that these clinical gains came at a very reasonable dollar cost. Specifically, telestroke treatment cost $2,500 per year of healthy life gained. This is much less expensive than the common spending limit of $50,000 per quality-adjusted life year.
“It is very important to treat a stroke case quickly because you can drastically reduce the amount of brain damage,” Saltzman said. “But you need a careful diagnosis. A medicine called tPA is very helpful in ischemic strokes, in which the blood supply to part of the brain is blocked. But tPA is very harmful in hemorrhagic strokes, in which there is bleeding into the brain. Telestroke allows an expert neurologist in a distant city to look at and interview the patient, while also reviewing the patient’s MRI scan. The video conference consult with the neurologist allows prompt administration of tPA in ischemic stroke patients while helping to avoid improperly administering tPA to hemorrhagic stroke patients or stroke mimic patients.”
“In Michigan, telestroke would be useful in areas like the Upper Peninsula where the population density is low and it’s impossible to support a lot of neurologists,” he added. “You could have a major hospital with a team of neurologists available 24/7 to serve as the hub with spokes going out to emergency rooms in rural areas. It makes a difference if you can give the correct medicine to a stroke patient even 30 minutes faster.”
One of the goals of the paper is to reduce the barrier of low reimbursement rates to the neurologists at the hub because insurance providers usually require physicians to make face-to-face visits with patients in order to bill.
“Seeing a patient on a two-way video monitor doesn’t count as much for billing purposes so they don’t get paid very much for it,” Saltzman said. “The practical implication is it’s worth it for insurance providers to pay for telestroke consultations because they help prevent catastrophic damage from a stroke. Insurance reimbursement systems need to be updated to reflect new telecommunication technology that allows a significant contribution to medical treatment to someone who is hundreds of miles away.”
Saltzman said he met the corresponding author of the paper, Jennifer Majersik, while teaching a class on the cost effectiveness analysis of medical care at the University of Michigan’s School of Public Health. Saltzman’s class finished in December of 2008 and Majersik approached him about being part of the research team.
The paper in Neurology is a slight diversion from Saltzman’s usual research in labor law, management-union relations, employee benefits, health services, labor union political action, and how employment conditions affect health.
“When I started graduate school I never anticipated being the co-author of a paper in neurology,” Saltzman said. “I like dabbling in lots of different disciplines and I like that I’m not pigeonholed into one narrow field at Albion. Albion encourages its faculty to have an interdisciplinary approach.”