AAN Neurology on the Hill

March 1, 2016
On Super Tuesday, March 1, 2016, members of the American Academy of Neurology met with our lawmakers to advocate for an act of congress to increase availability of acute stroke care. We were joined by a delegation of stroke patient advocates from the AHA/ASA.

The bill is called the FAST Act (Senate 1465, House 2799), which stands for Furthering Access to Stroke Telemedicine. Medicare currently only reimburses for telestroke consultation for patients presenting to hospitals in rural areas, and this bill seeks to expand coverage for patients originating in urban and suburban areas as well.

Though telemedicine has clear utility for patients in rural areas, the vast majority of patients fall victim to stroke in urban and suburban areas. Neurologists and stroke centers are more common in these areas, but this is not universally true. Increasing the availability of telestroke consultation could increase the rate and speed of acute ischemic stroke treatment in more areas.

A number of studies have examined safety, outcomes and cost-effectiveness of telestroke. Most of the data regarding telestroke come from studies in rural settings, in which telestroke systems safely and effectively aid in the treatment of stroke.1,2 Additionally, in urban Madrid, implementation of telestroke was associated with higher rates of IV-tPA administration, faster door-to-needle times, and a lower 3-month mRS scores.3 In terms of cost effectiveness, telestroke networks are at least cost-neutral and likely result in societal cost savings.2,4 Telestroke may have additional unique benefits in urban and suburban areas such as refining access to endovascular therapy.

Politically, this bill is considered a “win-win” bill. It is intended to benefit patients through expansion of coverage, yet is nonetheless expected, by AHA/ASA estimates, to generate considerable savings through the reduction of nursing home and long-term care facility use. Additionally, it has true bipartisan support with at least 25 Democrat and 25 Republican co-sponsors in the house. There is, therefore, a real possibility of this expansion becoming codified in law, whether through passage of the FAST Act or incorporation into other health care legislation.

The FAST Act would require Medicare to reimburse hospitals for telestroke regardless of geography, thereby allowing hospitals to build and strengthen the infrastructure for acute stroke care. The benefits are clear and may exceed expectations.

Concerned readers are encouraged to write to their senators and representatives. Members of the American Academy of Neurology can do so through the Action Center on the AAN website.

– Neal S. Parikh, MD

1. Stroke. 2014;45:2739-44.
2. Stroke. 2014;45:1876-80. [Review]
3. J Neurol. 2014;261:1768-73.
4. Am J Manag Care. 2013;19:976-85.