The combination of evidence that multiple EEGs increases the effectiveness of the study’s ability to diagnosis epilepsy, combined with the ability to record prolonged periods of sleep when the likelihood of epileptic activity may increase led to the performance of extended recordings with durations of one or more days – these have produced an increased yield in both detection of epileptic abnormalities as well as increased likelihood of capturing one of the patient's typical events.
The ability to lower anti-epileptic drugs so that the patient is more likely to have one of their events. Because of the risk of triggering generalized convulsions (or rarely, even status epilepticus), this practice mandates observation and the ability to intervene immediately if necessary (frequent with the use of IV medications); one can only lower drugs safely in the inpatient setting.
The ability to have a skilled observer (nursing staff) directly interact with a patient during the event, allowing for assessment of orientation, the ability to speak, etc. -w that might not be evident otherwise.
Scheduling the inpatient stay may create a significant delay between when the study is ordered and when it is executed.
Admission to the hospital may be difficult for the patient for multiple reasons, including cost, distance to inpatient facility and family/home obligations. As previously noted, there is not only a worsening shortage of neurologists in the United States, but access is further hampered by the tendency for neurologists to cluster in major metropolitan areas creating “neurology deserts” over large areas of the country.14
Cost: the cost is artificially high for services that are either not medically necessary (e.g., 24-h nursing, vital signs every shift) or needs that are just as well available at home (e.g., bed, meals and medications).
The hospital is an artificial environment with little stress for the patient, and their activity is minimized. The result is that patients who may have been having seizures frequently when home may not even have an event recorded. This fact contributes to the need for drug reduction and activation procedures with inpatients in the first place.
The study is performed in the regular environment and stress where the episodes in question generally occur.
The study can generally be scheduled and executed much more quickly than inpatient studies. Alliance in most cases has “next day” and “next week” availability, resulting in a much higher level of patient compliance with completion of the testing, and a much faster turnaround of the final report getting to the ordering physician.
The expense is generally a fraction of an inpatient study, as low as 1/6th of the cost for a 72-hour recording.
Patients can stay in the privacy and comfort of their own home, and do not have to travel to stay in an EMU (the distances in some cases may be significant). This results in less time off from work and away from family.
One cannot safely lower anti-epileptic drugs during the recording.
Studies that have evaluated the value of home video EEG monitoring in the past have also noted a decreased likelihood of the patient being on camera at the time of an event, and the inability to fix technical problems with the recording. With the advent of technology that allows for frequent web-based monitoring of the recordings, and the ability to either call the home (to fix patient position or pan/tilt/ zoom the camera position) or dispatch a technician to the home to fix technical problems, these are lessening concerns. The web-based software allows for remote real-time review of the study, so that the monitoring technician no longer needs to be on site, but is still able to contact medical or technical staff to intervene on a timely basis.
Indications for outpatient VEEG recording do not include the withdrawal of AED’s, therefore, no emergency / medical / nursing staff is available at the bedside.
The improvements in technology have led to the recent conclusion by the International Federation of Clinical Neurophysiology that “it is now possible with home video-EEG telemetry to extend the value of (ambulatory EEG) with addition of video, beyond seizure classification (supported by category 1 and 2 studies) to obtain information about non-epileptic diagnoses."
The Affordable Care Act and value-based care initiatives focus on shifting health care from volume to value. In that light, it is essential to capture the right code associated with the correct care to document the efficacy of those procedures which are proven to deliver better outcomes at lower cost for population health. If CPT code 95951 were not used for the services provided by Alliance, the critical differentiation between EEG with video and without video would be lost. Therefore, to NOT use 95951 would defeat the purpose of value-based care as envisioned in the Affordable Care Act with respect to EEG diagnostics utility in Neurology.
When performed as described, for the indicators listed above, home video EEG monitoring is both safe and effective as a diagnostic tool, with a utility equivalent to that of inpatient studies but having the dual benefits of increased patient comfort and lower cost.
It is anticipated that with continuing advances in home VEEG recording technology and web-based technician interfaces, the utility and cost-effectiveness of this procedure will only improve.
Epilepsy is a disease affecting the brain that predisposes the person affected to recurrent unprovoked seizures. The diagnosis is made after two or more unprovoked seizures.
Beyond the direct effects of seizures, people suffering from epilepsy may have a number of challenges including diminished family and social support, impaired cognition, medical and psychiatric comorbidities and societal stigma – all leading to a reduced quality of life.