US study tracks distance Medicare patients travel to see neurologist

Nearly 1 in 5 people on Medicare — a U.S. federal insurance program for people ages 65 and older — travel at least 50 miles (about 80 km) each way to see a neurologist, according to a recent report.

However, long distance travel was even more common for people living with complex neurological diseases such as multiple sclerosis (MS), amyotrophic lateral sclerosis (ALS), or brain cancer.

People traveling these long distances — who were disproportionately from rural areas with fewer nearby doctors — were also less likely to return for follow-up appointments.

The study, “Patient Travel Distance to Neurologist Visits,” was published in Neurology.

“Travel distance can be a serious barrier to care for people with chronic neurologic conditions,” Carlayne E. Jackson, MD, president of the American Academy of Neurology (AAN), which funded the study, said in a press release. “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.”

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People living with chronic neurological diseases like MS require routine care, including regular visits to a neurologist who can monitor disease progression and manage treatments.

However, specialized neurologists are often concentrated in urban centers, meaning many patients — especially those in rural and medically underserved areas — may not easily access this care. Physical disability, cognitive issues, or other MS symptoms also could  make it more difficult for patients to travel long distances to see their neurologist.

In this study, a team led by scientists at the University of Michigan examined exactly how far older adults in the U.S. are traveling to see a neurologist. They examined data from more than 563,000 people on Medicare who saw a neurologist at least once during 2018.

These patients were seen by 14,439 neurologists over more than 1.2 million office visits. Participants’ home ZIP codes were compared to their neurologist’s office ZIP code, with long-distance travel considered anything at least 50 miles apart.

Results showed 96,213 people (17%) traveled these long distances — on average 81 miles, or 130 km, each way — with an average travel time of 1.5 hours. For those who did not travel long distances, the average distance was 13 miles (20 km), taking 22 minutes.

Across neurological conditions, long-distance travel was more common for people with neurological conditions requiring multidisciplinary care, including brain or spinal cord cancer (39.6%), ALS (32.1%), and MS (22.8%).

Variety of reasons long-distance travel was needed for appointments

A number of different factors correlated with the need for long-distance travel, including living in an area with low neurologist density, living in rural areas, requiring long-distance travel for primary care, and neurologist visits related to ALS or nervous system cancer.

About a third of participants did not see the nearest neurologist, bypassing that office by 20 or more miles to see a different one, and 7.3% crossed state lines.

“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,” said Brian C. Callaghan, MD, study author and chair of AAN’s Health Services Research Subcommittee.

These long-distance travels also were  associated with lower odds of returning for a follow-up visit.

Among more than 165,000 people who saw a neurologist for the first time within the first three months of the study, 62,000 had at least one follow-up visit at the same office. The odds of such a follow-up visit were 26% lower among patients who had to travel long distances.

The analysis did not account for people who may have been referred to a neurologist but were not able to see one, and only included Medicare beneficiaries, marking study limitations.

Nevertheless, “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,” said Chun Chieh Lin, PhD, of Ohio State University, study author, and AAN member.

The study was conducted prior to the COVID-19 pandemic. Future research should focus on how the implementation of telemedicine practices during the pandemic influenced travel times and care access, according to Lin.

Moreover, “future work should evaluate differences in clinical outcomes between patients with long-distance travel and those without,” the researchers wrote.