A multicenter study published in Neurology adds evidence to one of the most important questions facing hospital leaders as virtual specialty care becomes a larger part of clinical operations: what happens after the virtual visit?
The Study
The study, “Virtual vs In-Person Neurologic Ambulatory Care: A Case-Control Study of Subsequent Health Care Utilization,” compared new outpatient neurology patients seen virtually with similar patients seen in person across three academic medical centers. Researchers found no major overall differences in the number of subsequent neurology follow-up, neurologic emergency department visits, neurologic hospitalizations, all-cause emergency department visits, or all-cause hospitalizations.
The study is an additional piece of evidence documenting that telehealth is substitutive, not additive, reflecting its cost effectiveness.
One of the most comprehensive looks at operational Medicare telehealth utilization patterns, new analysis of Medicare data from 1.67 million beneficiaries in 25 states and Washington, D.C. found that Medicare patients averaged just 0.25 additional visits per year, despite a 31-fold increase in virtual visits. The analysis, a project of the Center of Digital Excellence at the American Telemedicine Association (ATA) shows that telehealth is overwhelmingly substitutive, not additive.
Study Findings
After propensity score matching, the Neurology study compared 8,202 virtual neurology visits with 8,202 in-person visits. Neurology follow-up within 90 days was nearly identical between the two groups: 24.6% for virtual visits and 23.7% for in-person visits. Neurologic emergency department visits within 90 days were also similar, at 0.9% for virtual visits and 0.8% for in-person visits. Neurologic hospitalizations were comparable as well, at 1.8% and 1.7%, respectively
For hospitals and health systems facing persistent neurology access challenges, the findings offer a clear signal that virtual neurology care, when applied appropriately, can expand access to specialist evaluation without producing a measurable increase in subsequent emergency or inpatient utilization.
“Neurology depends on careful clinical history, pattern recognition and timely specialist judgment,” said Annie Tsui, D.O., chief medical officer, neurology at Access TeleCare. “This study reinforces what we see in practice: many patients can receive meaningful neurologic evaluation through a well-structured virtual model, especially when the program is supported by clear workflows, strong communication with onsite teams, and appropriate escalation pathways.”
– Annie Tsui
The study does not suggest that every neurology patient should be evaluated virtually. Some patients will still require an in-person neurologic exam, onsite testing or higher-acuity intervention. The researchers also found modest differences by chief complaint. Follow-up was higher after in-person visits for dementia, while follow-up was higher after virtual visits for Parkinson disease, multiple sclerosis and headache. Testing was more frequent after in-person visits for certain chief complaints.
Those differences point to the importance of clinical triage, program design and patient selection rather than a blanket approach to virtual care.
For hospital executives, that distinction is central. TeleNeurology’s value depends on how it is integrated into the larger care environment. A mature program gives hospitals access to board-certified neurologists while supporting the physicians, nurses and clinical teams already caring for patients at the bedside or in the outpatient setting.
Access TeleCare’s teleNeurology programs help hospitals and clinics strengthen coverage across neurologic care needs, including teleStroke, general neurology consults, teleEEG support and other specialist services. The model allows hospitals and clinics to extend neurologic expertise into settings where local coverage may be limited, inconsistent, or unavailable.
Without timely neurology support, hospitals may face avoidable transfers, delayed consults, prolonged emergency department stays and added pressure on hospitalists, primary care physicians and emergency clinicians. In rural and community hospitals, those pressures can be especially difficult to absorb.
“For hospital leaders, the question is how virtual specialty care strengthens the hospital overall clinical model.” said Joshua DeTillio, chief executive officer of Access Telecare. “TeleNeurology can help hospitals expand access, support onsite clinicians, retain appropriate patients locally and build more dependable specialty coverage in a service line where recruitment remains extremely difficult.”
– Joshua DeTillio
Neurology is one of the clearest use cases for telemedicine. Demand for neurologic expertise continues to rise, while many hospitals experience challenges securing consistent onsite coverage for inpatient and outpatient settings. Tele Neurology gives hospitals a way to connect patients and care teams with specialist input at the point of need.
It also helps move the conversation beyond whether virtual care can replicate every aspect of an in-person encounter. The more useful question for hospital leaders is where virtual specialty care can safely and effectively close access gaps, support clinical decision-making and help patients receive care in the right setting.
As hospitals continue to rethink specialty coverage models, the findings offer a measured but meaningful conclusion. Virtual neurology care can play a larger role in access strategy without automatically increasing follow-up burden, emergency department use or hospitalizations.