Telestroke Coverage for Community Hospitals

Acute stroke treatment is a race against time, and the decision to give a clot-dissolving drug depends on rapid expert assessment. Most community hospitals cannot keep a neurologist on call around the clock. Telestroke programs fill the gap with remote neurologists who assess patients by video and help the local team decide on treatment and transfer.

How telestroke works

When a patient with suspected stroke arrives, the ED activates a stroke alert. A remote neurologist connects by video, reviews history and imaging, examines the patient with the local team's help, and recommends whether to give thrombolytics. If the patient may need thrombectomy, the neurologist helps arrange transfer to a center that can perform it.

Most programs use a hub-and-spoke model. A comprehensive or thrombectomy-capable stroke center, or a telestroke company, acts as the hub. Community hospitals are the spokes.

What makes a program work

Response time. How fast the neurologist is on video after the alert is the metric that matters most. Put a target in the contract and measure it.

On-site readiness. Fast CT and CT angiography, a trained ED team, nursing protocols and medication ready to go. The remote neurologist cannot make up for delays inside the building.

Clear transfer pathways. Agreements with thrombectomy-capable centers, and transport arrangements, in place before the first patient arrives.

Data and review. Door-to-needle time, door-in-door-out time for transfers and outcome data, reviewed regularly with the provider.

Staffing a telestroke program

Most community hospitals buy telestroke coverage rather than build it. The provider has to staff 24/7 coverage with neurologists licensed in every state it serves, which is a significant licensure task on its own.

Hospitals with a local neurology group sometimes run a hybrid. Local neurologists cover days, and a telestroke provider covers nights and weekends.

Licensure and credentialing

Every telestroke neurologist must hold a license valid in the state where the patient is. Ask any provider how many of its neurologists are licensed in your state, because that number decides how resilient your coverage will be.

Each neurologist also needs privileges at your hospital. Credentialing by proxy can cut that work considerably, as long as the agreement meets Medicare requirements and includes performance reporting back to the provider. Our post on credentialing by proxy explains how it works.

Questions to ask a telestroke provider

1. What is your average and 90th-percentile response time after a stroke alert?
2. How many of your neurologists are licensed in our state?
3. Do you support credentialing by proxy, and what performance data do you need from us?
4. How do you handle simultaneous alerts across hospitals?
5. What data do you report, and how often?
6. How do you support stroke certification, such as Acute Stroke Ready Hospital?
7. Who supports the technology at 3 a.m.?

Beyond telestroke

Hospitals that succeed with telestroke often reuse the same setup for other specialties, such as ED telepsychiatry or tele-ICU. The licensing, credentialing and technology work carries over, which lowers the cost of each new service.

Frequently asked questions

What is telestroke?A model in which a remote neurologist assesses patients with suspected stroke by video, reviews imaging and helps the local team decide on thrombolytic treatment and transfer.

Does a telestroke neurologist need a license in the hospital's state?Yes. Each neurologist must hold a license valid in the state where the patient is located.

Can hospitals use credentialing by proxy for telestroke neurologists?Yes, when the provider qualifies as a distant-site hospital or telemedicine entity and the written agreement meets Medicare requirements, including performance information sent back to the provider.

What metrics should hospitals track for telestroke?Response time after the stroke alert, door-to-needle time, door-in-door-out time for transfers, and patient outcomes.

DirectShifts handles licensing and credentialing for specialty telemedicine programs and places neurologists for hospitals that build their own. Talk to us about specialty telemedicine coverage.