Parkinson’s disease is a progressive, neurodegenerative brain disorder that affects a person's ability to regulate movements, body and emotions. Most commonly diagnosed in patients older than 60, it is becoming more prevalent as the U.S. population ages. As many as 1 million Americans are living with Parkinson’s, and 60,000 new cases are diagnosed each year.
Because neurologists are in short supply in many parts of the country, more than 40 percent of patients diagnosed with Parkinson’s do not see a neurologist within the first four years after diagnosis. As their disease progresses, many patients suffer limited mobility, making it difficult to get to medical appointments.
But, like most patients with chronic conditions, individuals with Parkinson’s disease benefit from seeing a specialist on a regular basis.
“Those who don’t are more likely to lose their independence or more likely to fracture their hip or die prematurely,” says Ray Dorsey, M.D., a neurologist and director of the Center for Human Experimental Therapeutics at University of Rochester Medical Center.
Dorsey is a pioneer in the use of teleneurology to help individuals with Parkinson’s gain routine access to specialty care. He sees patients in their homes — using HIPAA-compliant technology similar to Skype — or at a nurse-managed Parkinson’s clinic in Delaware where, until recently, there was no neurologist.
“I don’t see patients at the clinic anymore. I almost exclusively see individuals over the internet,” he says.
Payers, traditionally reluctant to support telehealth, are getting on board; 29 states have laws requiring private insurers to cover telehealth services the same way they cover in-person services, and 48 state Medicaid programs cover at least some telehealth services. Medicare policy, which reimburses for telehealth services only in rare situations, is the biggest barrier to widespread adoption, Dorsey says.
From his office in Spokane, Wash., Jason Aldred, M.D., a neurologist in private practice, uses telehealth technology to provide follow-up care to patients at five clinic sites in eastern Washington. He also offers concierge-type teleneurology, in which patients pay out-of-pocket for a virtual visit in the comfort of their homes.
“Otherwise, patients from Montana would have to drive several hours over mountain passes,” Aldred says. “Paying $100 or so for a half-hour visit is not much compared with the cost of gas and a hotel and the risk of driving.”
And patients like the convenience of virtual house calls. Dorsey is leading a multicenter, national randomized comparative-effectiveness study comparing usual care in the community to usual care plus four teleneurology visits a year with a Parkinson’s disease specialist. Clinical findings have not yet been published, but the attention that the study generated was significant in its own right, he says.
“We had over 11,000 visitors to our website — from 80 countries and all 50 states — who were interested in learning about getting care for Parkinson’s disease in their home,” he says. “That shows a huge latent demand for getting care conveniently at home.”