Abstracts

Rationale: The primary purpose of this descriptive study is to assess the utility of telemedicine with respect to epilepsy care in a COVID-19 pandemic/post-pandemic era with discussion of the current state and future directions.

Methods: We conducted a descriptive analysis of the existing body of literature to assess the utility of telemedicine in caring for patients with epilepsy. Our analysis included patients with epilepsy of all ages in the COVID-19 era following March of 2020 while also drawing on our own institutional experience in this same time frame. A review of PubMed indexed articles was carried out for the terms “telemedicine and epilepsy” with additional review of independent resources provided by professional studies including the 2021 Telehealth Survey Report performed by the American Medical Association which was distributed to a convenience sample between November 1, 2021, through December 31, 2021, with 167 respondents from the field of neurology.

Results: Our preliminary analysis demonstrates that neurologists in the U.S. have emerged as ‘super users’ of telemedicine with 13% of all claims representing telehealth in April of 2020 with this number decreasing to 5.4% in January of 2022. On average, neurologists see 41 patients per week of which 15 are via telehealth though there is substantial variability across institutions. Most neurologists indicate that 75% or more of telehealth visits are with established patients with telehealth services being utilized in most states. Most neurologists use live audio-visual technology to deliver telehealth followed by telephone/audio only calls with much fewer neurologists utilizing asynchronous telehealth and remote patient monitoring. Several common themes have emerged in term of barriers to offering telehealth and this includes concerns related to roll back of COVID-19 Medicare waivers, payment policies with reference to reimbursement of telehealth services, and technology challenges for patients that includes access or lack thereof to broadband. Despite these challenges, a growing body of evidence suggests that telemedicine is effective in sustaining routine outpatient epilepsy care when a standardized approach to care and documentation is employed.

Conclusions: A growing body of evidence in the U.S. health care system supports the use of telemedicine in the care of people with epilepsy. Barriers to telemedicine revolve around payment policies and the impending roll back of COVID-19 Medicare waivers which have allowed these services to thrive. Congressional action is needed for telemedicine services to become permanent.  Several legislative fixes (S.3593/H.R.7573) are currently being considered in Congress which include a two-year extension of Medicare telehealth flexibilities after the public health emergency however a key challenge remains the costs associated with these changes estimated at $25 billion over 10 years. Future studies are needed to demonstrate not only the potential positive impacts of telehealth in epilepsy care (improved access, compliance, etc.) but also long-term cost savings.

Funding: There were no funding sources in support of this abstract.