On Epilepsy, Insurers Should Follow Their Own Rhetoric on In-home Care

Jeremy Slater, MD

Jeremy Slater, MD, is Chief Medical Officer for the Alliance Family of Companies, which includes Respiratory Sleep Solutions LLC. He served as the Director of the Texas Comprehensive Epilepsy Program from 2004 to 2017. The piece reflects his views, not necessarily those of the publication.Health care professionals and researchers interested in responding to this piece or similarly contributing to MD Magazine® can reach the editorial staff by submitting a request here.

In a pre-merger report on health care trends, Aetna hailed technology that monitors patient health and delivers in-home treatment as one major approach that can help the US catch up with other developed countries on health outcomes and life expectancy. One company official even declared: “Whenever appropriate, keep people in their homes.”

But this rhetoric doesn’t apply to the 150,000 Americans who are diagnosed with epilepsy each year, or countless more who don’t yet know the source of their seizures—at least not if their insurer is Aetna.

Like many neurological disorders, epilepsy demands careful monitoring to determine proper treatment protocols. One of the first critical steps is a neuro diagnostic test (or EEG test). It tracks and records electrical activity in the brain, providing physicians with critical data that informs patient care.

This type of testing has been available to patients at both in-patient epilepsy monitoring units and via in-home diagnostic providers. And the research is clear: both are equally effective.

Yet, despite previously covering and paying for in-home diagnostics, Aetna’s new payment policy now effectively blocks access to in-home EEG testing by refusing to cover the cost of this proven diagnostic approach, which is often the only viable option.

Consider that the majority of US states and territories have just 2 or fewer National Association of Epilepsy Center (NAEC) designated epilepsy monitoring units (EMU) capable of conducting in-patient EEG testing. This includes 14 states with just 1 such facility and another 5 without a single monitoring unit within state lines. When compared to Centers for Disease Control and Prevention (CDC) patient data, this suggests that there are at least 356,000 patients with epilepsy living in states with one EMU or none, and that number jumps to more than 776,000 patients when considering states with just 2 EMUs. By limiting patient access to in-home diagnostics, Aetna’s policies bring hardship to thousands of vulnerable patients.

These “neurology deserts” have been a top concern regarding dementia and Alzheimer’s treatment for years, but the ramifications regarding access to epilepsy care is arguably even more acute given the specialized monitoring needs associated with the disease.

In addition to obvious geographic concerns about the ability of patients to reasonably access EMUs, still other evidence suggests that cutting off access to in-home care isn’t just a concern for rural areas. NAEC data suggests that EMUs alone can’t meet the existing demand for testing. A mere 50,000—60,000 EEG patients are admitted to EMUS annually—approximately one-third of the total number of new patients diagnosed with epilepsy. And wait times to be admitted to an EMU average 3 to 4 weeks, according to NAEC data, compared to next-day or next-week options for in-home diagnostic care.

In other words, if you recommend an EEG to your patient, their option is to wait a month to be seen—if at all. If this patient has children, they’ll likely need day care before traveling a great distance and spending days away from home and work. They’ll do all of this even though there is an in-home option available.

Add to this a major disparity in costs to patients and the healthcare system overall between in-patient testing and in-home testing. With an average in-patient stay for EEG testing ranging between $35,000 and $40,000, out-of-pocket costs to patients could hit $6,000 or more if we assume a 20% co-pay. At minimum, such a stay is likely to ensure that that the patient must pay their full annual deductible.

Meanwhile, in-home testing that delivers the same testing protocol can be achieved for one-sixth the cost, delivering results to the ordering physician within 48 hours of completion. This not only guarantees swift access to care but keeps costs manageable for patients.

The question to Aetna is this: Why stand in the way of a proven testing approach that is more convenient and less costly for both patients and payers?

While I can’t answer that question for Aetna, my company is fighting to make them change their mind. If CVS and Aetna are truly charting the future of healthcare in this country, then it’s long past-time that their actions align to their rhetoric.