Medicare Patients Are Traveling Shocking Distances Just To See A Neurologist

MINNEAPOLIS — Medicare is supposed to make healthcare in old age easier and more convenient, but researchers working with the Academy of American Neurology suggest that a troubling number of older Americans are traveling great distances just to see a neurologist — a doctor who diagnoses disorders in the brain. Study authors report close to one in five Medicare recipients travel 50 miles or more (one way, not roundtrip) to see neurologists.

All in all, this project suggests patients dealing with serious conditions such as brain cancer, amyotrophic lateral sclerosis (ALS), and multiple sclerosis (MS) — which call for specialized neurologic care — are traveling great distances to get the medical attention they need.

“Our study found a substantial travel burden exists for some people with neurologic conditions, including people living in areas with fewer neurologists and rural areas,” says study author and Chair of the American Academy of Neurology’s Health Services Research Subcommittee Brian C. Callaghan, MD, MS, FAAN, of University of Michigan Health in Ann Arbor, in a media release. “We also found that people who traveled long distances were less likely to return for a follow‐up visit with a neurologist.”

“Travel distance can be a serious barrier to care for people with chronic neurologic conditions,” adds American Academy of Neurology President Carlayne E. Jackson, MD, FAAN. “The American Academy of Neurology is committed to improving access to high-quality neurologic care because consistent access to specialized care from a neurologist is essential to help people manage their symptoms and minimize risks of dangerous complications and side effects.”

In all, this project included over 563,000 people on Medicare who visited a neurologist at least once over the course of the one-year study. The average age of these participants was 70 years-old, and researchers accounted for the age, sex, race, ethnicity, and neurologic condition of each person. Over the course of the project, a total of 14,439 neurologists provided care to participants during more than 1.2 million office visits.

To measure travel distance, participants’ home zip codes were compared to their neurologists’ office zip codes. A long-distance trip was defined as a doctor’s office located 50 or more miles away. Incredibly, more than 96,000 people (17%) traveled long distances, with an average of 81 miles traveled one way and an average travel time of an hour and a half. Others who didn’t usually travel long distances went an average distance of 13 miles and had an average travel time of 22 minutes.

Regarding neurologic conditions, long‐distance travel was most common for people with brain and spinal cord cancers; 40 percent of such patients traveled long distances (30% for ALS, 23% for MS).

The study details a number of factors found to be associated with long‐distance travel. For example, those living in areas with the fewest neurologists (10 neurologists per 100,000 Medicare beneficiaries) were three times more likely to travel long distances than others living in areas with the most neurologists  (50 per 100,000 Medicare beneficiaries). Others living in rural regions also displayed a five times greater chance of traveling long distances than those living in cities and more urban areas. Additionally, patients traveling long distances to see their primary care physician were three times more likely to travel a similarly long distance to see a neurologist.

Close to a third of the patients bypassed the nearest neurologist by 20 miles or more to see a different neurologist, and another seven percent even crossed state lines for neurologic care.

“It is possible some people bypass the nearest neurologist as a matter of preference for a particular physician or they may need to travel farther to reach neurologists with shorter wait times,” Dr. Callaghan notes.

Among the 165,000+ patients who visited a neurologist for the first time within the first three months of the study, 62,000 had at least one follow-up visit with the same doctor. Those traveling long distances were 26 percent less likely to attend a follow-up visit compared to those without long-distance travel.

“Our results suggest that policymakers should investigate feasible and affordable ways to improve necessary access to neurologic care, especially in areas with low availability of neurologists and in rural communities,” explains study author Chun Chieh Lin, PhD, MBA, of Ohio State University in Columbus and a member of the American Academy of Neurology. “Interventions such as telemedicine can improve access to care. Future research should examine the differences in health outcomes between people who must travel long distances for care and those who do not.”

This study was conducted prior to the COVID-19 pandemic. Thus, researchers note future followup projects should consider how telemedicine during the pandemic influenced patient travel times.

It’s important to note that this study was limited by a number of factors. To start, researchers were only able to account for travel among patients who completed neurologist visits. They did not gauge potential travel times among those who were referred but were unable to see a neurologist. Another limitation was that only Medicare beneficiaries were assessed, meaning results may differ across other populations.

The study is published in the journal Neurology.