Authors :
Presenting Author: Carol Riley, R.EEG/EP T, CNIM, RPSGT. – Boston VA HealthCare system
Ronda Tschumper, R.EEG/EP T, CLTM – EEG Supervisor, Neurology, Madison VA Medical Center; Jay Pathmanathan, M.D., PhD. – M.D., Neurology, Boston VA. Healthcare System; David McCarthy, M.D. – Chief Of Neurology, Neurology, Boston VA. Healthcare System
Rationale:
Access to Electroencephalogram (EEG) testing is essential for delivering high quality epilepsy care to Veterans. EEG testing in the VA Healthcare System increases continuity of care and is less expensive than non-VA community care referrals. Poor recruitment, salary rates and retention of VA EEG Technologists has resulted in temporary and permanent closures of VA EEG Labs. Reductions in operational VA EEG laboratories reduce access to epilepsy care and delay diagnosis and targeted treatment. Here we examine the shifts in operational routine EEG labs across the Veteran’s Affairs (VA) Health Care System, the largest healthcare system in the United States.
Methods:
We queried the VA National VSSC encounter database for VA EEG specific stop code (106) to identify total and site specific VA EEG encounter volumes per fiscal year from 2018 to 2022. EEG labs were considered active if FY volume exceeded three studies per year (an arbitrary, non-zero cutoff to ensure exclusion of labs erroneously using the 106-stop code). Previously active labs were considered closed if they performed zero studies in a fiscal year.
Results:
One hundred two VA EEG labs were identified at the start of the study period. Over the course of the five year analysis window, eighteen labs closed and nine labs opened – resulting in a net 8.8% loss of VA EEG labs nationally. The maximum loss occurred in fiscal years during and just prior to the COVID pandemic (2019 and 2020). In addition to lab closures, there was a universal decline in EEG volumes over the five year assessment in all geographic regions, with a national study volume decline of 24% from 21,590 studies in 2018 to 16,380 studies in 2022.
Conclusions:
EEG studies have declined across the VA Healthcare System from 2018 to 2022. The decline in routine EEG volumes has the decline in EEG labs, although study volumes may have stabilized since 2020. We hypothesize that several factors contributed to this decline; policy changes resulting in increased EEG community care referral, (Mission Act enacted June 2018), effects of the COVID-19 pandemic (March 2020), and a national shortage of EEG technologists. The decline in routine EEG recording may also reflect a trend towards greater utilization of ambulatory EEG monitoring conducted outside the VA (Community Care). As the VA grows tele-health, tele-neurology, tele-epilepsy and tele-EEG, the demand for EEG services is expected to rise. The source and direction of these trends require further investigation to ensure the ability to meet the care needs of our veterans.
Funding: none