American Academy of Neurology Telehealth Position Statement.

Telehealth services complement in-person neurologic care. The American Academy of Neurology supports patient access to telehealth services regardless of location, coverage for telehealth services by all subscriber benefits and insurance, equitable provider reimbursement, simplified state licensing requirements easing access to virtual care, and expanding telehealth research and quality initiatives. The roles and responsibilities of providers should be clearly delineated in telehealth service models.

Neuroimaging for the Neurologist: Clinical MRI and Future Trends.

MRI is a commonly used diagnostic tool in neurology, and all neurologists should possess a working knowledge of imaging fundamentals. An overview of current and impending MRI techniques is presented to help the referring clinician communicate better with the imaging department, understand the utility and limitations of current and emerging technology, improve specificity and appropriateness when ordering MRI studies, and recognize key findings.

Utilizing the Axon Registry® for quality improvement.

In 2015, the American Academy of Neurology began development of a clinical quality data registry now known as the Axon Registry®. The data collected by the Axon Registry and reported back to participants include performance on a number of quality measures relevant to neurology practice. While the Axon Registry may serve any number of needs for neurology practices, the essential function of the registry is to inform neurologists regarding the quality of their care and provide them with a tool to establish not only performance baselines but progress toward improved quality of care. This article includes 2 case studies of how the Axon Registry has been implemented in neurology practices to date. In the future, implementation of patient-reported outcome data and additional outcome measures will be necessary to expand the reach and effectiveness of the Axon Registry as a quality improvement tool.

Medicare payment transparency: Implications for neurologists.

In 2014, the Centers for Medicare and Medicaid Services began a now annual process of releasing payment data made to physicians and other providers from Medicare Part B. The unprecedented availability of detailed payment information has generated considerable interest among policymakers, the public, and the media, and raised concerns from a number of physician groups. In the current climate of financial transparency, publication of Medicare payment data will likely continue. In an effort to prepare neurologists for future releases of payment data, we review the background, limitations, potential benefits, and appropriate responses to Medicare payment data releases.

Neurology advanced practice providers: A position paper of the American Academy of Neurology.

There are many factors driving health care reform, including unsustainable costs, poor outcomes, an aging populace, and physician shortages. These issues are particularly relevant to neurology. New reimbursement models are based on value and facilitated by the use of multidisciplinary teams. Integration of advanced practice providers (APPs) into neurology practice offers many advantages with new models of care. Conversely, there are many and varied challenges financially and logistically with these practice models. The American Academy of Neurology has formed a Work Group to address the needs of both neurologists and neurologic APPs and monitor the effect of APPs on quality and cost of neurologic care.

Neuroimaging trends and future outlook.

Imaging equipment is experiencing advances in speed, sensitivity, safety, and workflow. There is an increasing trend toward physiologic imaging and quantitation, requiring greater consistency across manufacturers and clinics. The Human Connectome Project is symbolic of the drive toward combining multimodality anatomic and functional imaging with quantitation and sophisticated atlases. Advanced visualization methods have become essential in the evaluation of large multidimensional data sets. Hybrid imaging blends advantages from multiple modalities to provide a comprehensive anatomic, functional, physiologic, and metabolic data set. Breakthrough clinical neuroimaging applications are derived from an alignment of scientific, engineering, clinical, and business conditions.

Recovery audits: Practical update for neurology practices.

Recovery Audit Contractors (RACs) are contracted by the federal government to review providers' medical billing. Experience has demonstrated substantial savings to the strapped Medicare fund, fueling increased scrutiny. RAC audits are constrained to published focus areas, and its targeted approach makes use of sophisticated analytics. Although some of the analyses used by the RACs may be proprietary, much of the auditing process is transparent, allowing providers to prepare their practices in advance of audits. This article reviews the current state of RAC auditing and offers strategies to minimize financial pain and leverage the process for competitive advantage.

The practice of neuroimaging within a neurology office setting.

Imaging is an essential tool in the diagnosis and management of neurologic disorders, yet its adoption in the clinical neurology setting is limited. Perceived cost barriers and political pressures have caused undue apprehension for a community of experts that otherwise plays a leadership role in solving complex neurologic puzzles. Some private practice neurologists have integrated advanced imaging services into a comprehensive neuroservices model, demonstrating its plausibility together with a recipe for success. The purpose of this article is to explore the advantages, disadvantages, and considerations for integrating imaging into an outpatient neurology clinic. Clinical and business advantages are weighed against financial, regulatory, and political risks.

Volumetric CT: creating a new paradigm for image acquisition and review.

With the advent of fast, thin-slice CT, volumetric imaging is a practical and dose-efficient reality. However, the acquisition of many image slices at 0.5 mm thickness requires a new paradigm in image review. This article describes a hierarchical approach to handling the vast data set. The use of volume rendering and multiplanar reformatting techniques are critical in the process. Implementation of this approach at Long Beach Memorial Medical Center has resulted in greater clinical use of CT and improved diagnostic accuracy, while maintaining an acceptable throughput.