At Penn State, telemedicine boosts stroke care to rural patients

In July 2012, Penn State Milton S. Hershey Medical Center, a 563-bed children's and university hospital in Hershey, Pennsylvania, launched a telemedicine network to provide stroke care to rural patients in Central Pennsylvania. The hub-and-spoke network, which started off with five initial partners, now has doubled in size, and, according to neurologist Raymond Reichwein, is set to add four more partner hospitals over the next six months.

"Most of the new partners coming on board is due to word of mouth," Reichwein told FierceHealthIT. "We didn't have to go out and look for partners, which is unique."

Reichwein (pictured), in an exclusive interview, talks about the program's rapid growth, as well as how it has boosted care quality for some of the Keystone State's most critical patients.

FierceHealthIT: Talk a little bit about how telestroke has improved care for patients.

Reichwein: In various parts of Central Pennsylvania, there are critical access hospitals and limited access to stroke expertise, let alone neurologists and neurosurgeons. The telemedicine component provides access at these critical access hospitals for patients to be seen by stroke experts in a timely fashion.

With telemedicine and urgent evaluations, we're able to provide time-based treatments promptly. Intravenous t-PA treatments for stroke have increased substantially with the use of this technology and this kind of network system--at least in our system for some of these hospitals, by 500 percent.

Some of these hospitals had never treated a patient, or rarely treated a patient--now they're treating several patients in a given year, and some, a few per month. It's dramatically changed the treatments.

Additionally, it also allows us to select out the more severe patients who really should be transferred to a higher-level care facility in a timely fashion.

FHIT: What financial benefits have you seen?

Reichwein: There is a financial benefit to the outside hospital system because, theoretically, three-fourths of the patients they can keep.

On our end, we want, as an academic center, to take care the higher-level, comprehensive, complex stroke patient. Rather than transfer every patient in, we want to bring in the highest level of care patients by how we're built and designed. When you bring those in, a number of those patients may require procedures, which carry more revenue. Our goal is to help the patient, but as a result of procedures, there's a financial gain that comes with that.

We also look at the whole financial picture. In the telemedicine world, as far as reimbursements, it's kind of limited. If you just did consults via the current billing structure, it's really not financially lucrative at all. The system would not be sustainable. What we did for our system is we took all of the different aspects of anything tied to the stroke patient--the procedures that go with the acute care and all of the follow-up care and rolled it together. Let's say we found an aneurysm and the aneurysm is dealt with, that all gets rolled together. When you look at the whole product, as to the consults and also the procedures and secondary follow-up, it becomes financially sustainable.

FHIT: How does this program compare to other telestroke programs?

Reichwein: I think the one thing that makes us unique is the comprehensive follow up and the depth of what we cover. It's not just the acute consult and the acute intervention; it's really working as a partner across the spectrum of care.

We also go out quarterly to the different sites and meet with them to review their data and come up with a performance improvement plan that will benefit them.

At a lot of other systems, the hub site does a great job on the consults and transferring the patients. That care is good, but there's less information and less of a process tied around the spoke site--how well the spoke site does, the follow up, etc. We roll it all into one.

FHIT: What lessons have you learned, so far?

Reichwein: Data does change performance. As an example, one of the sites originally thought they were doing better than they were. We presented data to them and showed them problems with their processes, and they ended up changing around their entire staff and process based on the data we shared.

You need to have the right infrastructure at both the hub and the spoke site. This is not something where you just jump in to help people out, it's a much more complex process. The technology, the bandwidth and the interaction are all important, but if you don't have the right structure, the right personnel, the right pathways or protocols--and if you have gaps in any of those areas--you can easily compromise care and outcomes quickly. 

Editor's note: This interview has been edited for length and clarity.