In this episode of Health Biz Talk, Tony Trenkle, former CMS CIO, sits down with Dr. Nima Mowzoon, CEO and Co-founder of TeleSpecialists, to discuss how he revolutionized stroke care through tele-neurology. A Mayo Clinic-trained neurologist, Dr. Mowzoon shares his journey from practicing in Florida to building a national telehealth platform that delivers life-saving stroke interventions within minutes. He outlines the operational hurdles, technology innovations, and clinician coordination required to create a scalable, high-impact telemedicine model—especially in time-sensitive emergencies where “time is brain.”
Their conversation dives into the broader implications of telehealth, including AI’s role in backend operations, the evolving regulatory landscape, and the unique challenges faced by rural hospitals. Dr. Mowzoon emphasizes the need for better reimbursement models and stronger government support to close care gaps, especially in underserved communities. He also reflects on the value of patient-centric care and the future of specialty telemedicine as a permanent and powerful fixture in modern healthcare.
Transcript of the Podcast
00:00:00 Intro
Welcome to HealthBizTalk, the industry’s leading podcast that brings you today’s top innovators and leading voices in healthcare, technology, business and policy. And here’s your host, Tony Trankle, Former CMS CIO and health IT industry leader.
00:00:12 Tony
Hi, I’m pleased to welcome Doctor Nima Mowzoon, the CEO and Co Founder of TeleSpecialists to our podcast today. Doctor Mowzoon transformed emergent neurologic neurology from hospital protocols to national telemedicine innovation, bringing Mayo Clinic trained expertise to every corner of America. His pioneering work and stroke care delivery, from delivering developing rapid response protocols to establishing comprehensive neurological programmes, positioned him to revolutionise neurological access through telehealth. Under his leadership, TeleSpecialists has become the leading platform ensuring critical neurological expertise reaches patience precisely when and where it’s needed. So welcome Nima to the podcast. And as we always do, we ask how you got from from there to here today. And so any kind of further information you want to talk about your background or any major career change points that you came along the way that led you to where you’re at today?
00:01:27 Nima
Thank you very much for having me and, and thank you for the questions. Yeah, it’s been a, a journey for me. So I started, let me tell you a little bit about my, my background and how I got here. I’m a by training. I’m a stroke physician. I did my internship, residency and fellowship and all of that at Mayo Clinic in Rochester and I ended up in in in private practise eventually in Florida. So it was a journey to get to Florida. Long story short, bulk of my practise was was a stroke care and both inpatient and outpatient and start to focus a lot on the inpatient and became a stroke director of a system eventually here in Fort Myers. And that’s how I end up in Fort Myers. So lived in Fort Myers, FL for a little more than a decade before I decided to open up this this venture in telemedicine.
00:02:26 Tony
Right, right. Well, as we said in the introduction, you were kind of a pioneer in telemedicine for neurology and now have expanded to other telehealth areas. So can we talk a little bit more about the use case and the challenges you faced, turn your ideas into a sustainable business operation and and also of course, from a clinician standpoint, how it’s been able to help patients. Really when you started, the infrastructure was not there. So I think part of your challenge obviously was, was getting the infrastructure established, but what kind of use cases and operational flow did you really look at as you came to this conclusion of this was the way to go?
00:03:13 Nima
Sure, sure. So when we started, this was, we started the company in 2013, started operations in 2014. And back then telemedicine was not really known. It was known to patients. It was unknown to physicians, it was unknown to hospitals and providers. And so it was a kind of an outlandish idea at the time. And even when I was first exposed to it a few years before that, you know, we’re not the very first ones that started it.
But when we started to look at the technology that would be available, it was very little that was known before that. And I thought, you know, I couldn’t really understand the concept that all myself as a physician when we got really busy doing stroke care and I had to travel between two hospitals back and forth trying to get to the hospital in my car to see a stroke patients that I was called to see. By the time I get to the hospital, much time has passed. Stroke care is really very critical that at a timely basis.
So I really saw a very big need for stroke care and it came to a point where we really realised that we’re just not really doing right by patients by this model. And this is the conventional model without telemedicine. You know, there’s a a lack of access to neurologists and let alone at the very moment of need. We’re not talking about the hour of need, we’re talking about the moment of need right at bedside. So it was really impossible to be able to provide the quality of care because it’s really it’s driven by time, you know, time is brain. So I started to look around at the time to look at vendors that were doing telemedicine.
There was only a couple and they’re very at the beginning of their venture as well. And so we decided, so why not get my partners in crime and, and start a programme here at the at Lee Health at, at our backyard in Fort Myers. So that eventually got started and it was very successful. We actually started in Tampa region with a few HCA locations and it was very successful. We understood how we could get to bedside within two to three minutes very quickly. And now the question is how do you operationalize the scale? And that was really the the learning curve. How do we get to where we are with one or two cases, you know, at the very small scale. Now you have to put together a large group of physicians, large group of the hospitals. These calls come in randomly or semi randomly and these are strugglers.
So patients are not scheduled for these visits. So we have to have somebody available at all times to be able to see that patient very quickly within 2-3 minutes. That was always a challenge to operationalize that. So very quickly we realised we needed this is this is a really a distribution model, did this really is a call centre, is a distributive call centre. So we started to to work with a vendor and very quickly after that we realised that we need to do it ourselves. So we started to in house bits and pieces of this platform that we now have a still a specialist and that first part of that was the call centre and how we distribute, you know, the stroke Lersa come in to make sure they’re on the on the other side. That was the very beginning of that match.
00:06:44 Tony
It’s very interesting. I from a personal standpoint, my mother-in-law suffered a massive stroke a number of years ago, about the time, a little bit before when you started your, your practise. And of course she didn’t get treated in time, so she never really recovered and died a number of months later. So I understand that the need for her speed and for getting the right things in place before, you know the brain damage really starts setting in.
00:07:18 Nima
It is the one of the leading causes of morbidity, which is disability and mortality. And unfortunately I think most people around have been affected or have had someone that was affected to the stroke, myself included. You know, my my father just had an event not too long ago.
So I was happened to be now on the patient’s family side of the of the care episode, which was a whole different experience. But yeah, bringing the the provider to bedside as quickly as possible so that we can save brain what what’s been known as the in the world of stroke care as the golden hour. So the sooner we can just what what really happens is that clot gets clogged up in one of the arteries and the sooner we can get that flaw of that artery to that part of the brain, the more function you preserve brain dies very quickly.
You know, one each minute, 2 million nerve cells die. So it’s, it’s, it’s, it’s very drastic when you think about it. And these arteries are millimetres are, are less than millimetres or two millimetres in size small. And these, these arteries that are very small go to major part of the brain. So that it’s really amazing how quickly the need is to give that Cloudbuster to open these vessels up. And now the technology is pretty amazing. We can move beyond the Cloudbuster medication and if it doesn’t work and the club doesn’t break, now there’s interventionalists, there are specialists. We can go in there, do an angiogram, go into the artery and actually get the clot out. But obviously everything has to have good timing. So if things are late then then it’s too late. Then the brain already dies.
00:09:00 Tony
So from a operational flow, do you work with the local medical Staffs or how do you set up your relationships with with people who are actually on the ground because a lot of yours is being done remotely?
00:09:13 Nima
Yeah. It’s a very interesting model actually. So the same way as we service more than 440 facilities across the United States, our physicians are also bunker across the United States. And so it’s not it really in one facility. It’s really spread out and they all have their stations in different states. That’s really important for a number of reasons, but one of those reasons being, well, what if we get a hurricane here next time in four months? So what happens is when a stroke alert comes, there are several positions at any one point that can take that stroke alert.
So they, there is an automation of dispatch that it, it’s an intelligent routing and queuing with AI models that are integrated in it. So it understands who is available, who’s licenced credential, if you have to be licenced credential and who’s available to take the stroke alert. And and then there’s other, there’s other algorithms that gives it the role of who is the best person to take that stroke alert. So it automatically in seconds or less than seconds, it gets dispatched to the person. If the person cannot accept it, it will automatically go to the next person. So that automation is critically important for this. So I remember when we tweaked and fine-tuned this programme, we started this programme quite a long time ago, but we were actually able to reduce our response times.
There’s a technology that we put in place, made it very scalable. Imagine if you didn’t have the technology and the calls come in, you would have to look up the list. It’s impossible. So that was a key component to scaling this business that is really a call centre distributed model kind of business.
00:11:07 Tony
Yeah, I I find that fascinating. So you don’t. It’s kind of a centralised, decentralised approach. So basically when the call comes in, it automatically gets routed geographically to where it’s needed. Is that how you work then?
00:11:24 Nima
Exactly right. So when you that’s exactly a very good way of putting it because when you’re really looking at it and you compare it to the commercial model, what’s the conventional model? The Commission model is you have a system, a healthcare system of hospitals and we call hub and spokes. There are several spoke locations, if you will, several smaller locations that refer patients to the bigger location, comprehensive stroke centre in the bill of that system.
So in order to really create a service that’s 24/7 with fast care across this healthcare system, you have to hire at least 10:50 to 13 neurologist depending on the volume per site and to carry the quality and to be able to provide value. And really that poor access of neurologist right now makes that impossible. So instead what we did was we said, OK, how about if we now centralised this staffing model and have a centralised a group of really good stroke neurologist, the best of the best across the country you do all day long is stroke care and we’re centralising everything here. So the quality management from that to getting with the licences and the credentials and the enrollment into payers and you know, all of those services and everybody needs to have there’s, there’s audits and all kinds of things that need to happen.
Well, we centralised all those resources. So you reduce your cost, but you also improve the quality. So now you have this centralised resources that are really physicians that are really across the country, but it’s naturalised because it’s all on video. The calls come in and they and, and these guys are on schedule. They have a call schedule. So but when the calls come in, they go to these guys and when they’re off the screen, they’re ready for the next call. So it’s kind of a model that goes on and on and on. It’s kind of like a like an ongoing physician selection in a matter of seconds and kind of a supply chain, if you will, a circular supply chain model between the physicians that come in and then the hospital, the cases that come in from the hospitals. This needs to happen 24/7. So the backhand, the predictive models on when do we get more consults, when do we get less consults, how do we staff up to times where we need the staffing. A lot of work goes behind with you at the end of the day. The product is that we have 40 to 50 physicians just doing stroke care and about 30 other physicians just doing hospitalist care, seeing general neurology patients on the floor and if she was psychologist at any one time.
So there’s about 200 plus physicians that are staffing this model on an ongoing basis and this is all that they do. So that’s where really the true benefit of telehealth comes in because you it has to be linked to the right operational model, the right staffing model. And I always say to everybody, you know, our business is kind of like a, if you will, if you can imagine a Venn diagram of three circles and one is obviously the value, the central of that is the value to patients. But you’re talking about how to create the business. There’s value to the clients, which are hospitals where B to B business value to the company obviously.
And then there’s value to physicians. And for physicians, it has to make sense. They have to have the income, has to be good, the hours and all that. It has to basically match what their needs are in order to for. So that’s value proposition for these three circles is right in the centre. And that’s what makes a business and telehealth to be sustainable, you know, everyone has to see the value of it.
00:15:14 Tony
Yeah, I agree with that. And I think obviously the the pandemic changed some things as well. And then you had the fast AC which expanded Medicare payment for for stroke victims, for telemedicine. But I guess if if someone’s trying to get it started in this area, what’s the what are some of the critical SuccessFactors that you found?
00:15:40 Nima
Yeah, I think the what I my philosophy has always been to focus everything, your, your, your care, your operations and everything on the patient. And the patient’s what I call the patient’s value stream. Let’s focus on what is the experience of the patient and how quickly are we able to get to the patient and how is that interaction and how we can make that interaction a good quality. I mean, I can get the best position on the screen, but if the interaction is poor, then the patient experience is poor if the best position on the screen immediately. But if I can’t get the CT scan in time or I can’t get the laboratory in time or I can’t get this and that, there’s going to be delay in the treatments. So stroke here just happens to be very unique in that there’s a lot of moving parts and variables that that jump on that value stream, so.
00:16:42 Tony
Yeah, I, I agree with you and that’s why I’m thinking. I, I, I feel like you’ve taken that model and kind of flipped it. A lot of people have looked at technology as kind of an adjunct, whereas you’ve basically taken technology and obviously you’ve got, you’ve got a really talented group of clinicians. But I think you made that kind of your, your business driver as opposed to a lot of people with the telemedicine or, or telehealth area. They’ve, they kind of look at it as an adjunct, you know, and I, I think you’ve, you’ve kind of turned the model upside down. Is it, you think that’s more for your specialty or do you think it’s something that more doctor?
I mean, obviously it’s done well with, with mental health. People don’t want to come into the, you know, they don’t want to come into the office. So they can, you know, get the treatment in their home. You know, more dermatologists are starting to use it. There’s a number of other doc doctors that are getting into it, but I I never found any of them that have really adopted the way you have. Do you think yours is unique just because of way you’re thinking or is it something that the rest of the industry really has to wake up to? It’s a.
00:18:02 Nima
Good question. You know, I think that I think the key thing here is to really try to understand how you can operationalize telehealth. So in order to operationalize it, what else do you need? And it goes back to the patient experience and the patient value stream. What else do you need to operationalize?
And the stroke happens to be one of the more complicated ones because there are a lot of moving parts. And one of the simpler ones to understand and do is telepsychiatry. Telepsychiatry, the interaction is really the patient and the physician and, or the family in case of minors and whatnot and, and then maybe other factors that come in that, that need to provide some more information about that episode of care and whatnot. But that’s where it is. It’s really quite simple. And the ambulatory and outpatient model is really between whether it’s a therapist or a, or a psychiatrist. The model is just between the two people, you know, fairly simple model to understand. Whereas with everything else, even with primary care, there are a lot of, there are a lot of things you’re limited on, you know, as a physician, you can’t really do a hands on exam up on ground.
So I think the part that got lost in the business of telehealth when the pandemic hit, everybody was desperate to see their physicians and they will basically do anything, they’ll concede to anything that works. But then when you talk about the post pandemic zone, the post pandemic area, how do you actually create value, Value proposition becomes very different. Now you don’t have that desperation. So the models where the physicians can’t build a rapport and can’t really touch the patients in that in the model of outpatient, how the health for, for instance, for primary care doesn’t work very well if you don’t have good health on ground. So I like to see patients from homes. In my opinion, it doesn’t really work.
What if now you have a model where you have you’re in an ambulatory centre and you don’t have the physician specialist, but you have a nurse practitioner on the ground that can examine the patients really well and they get trained on how to assess the patients and that really well and they work with you so. That’s now in the evolution of the company. You know, we’ve perfected the art of how we can get to emergencies in the ER, both psychiatry emergencies and neurology emergencies, and how we can get to inpatient floors around outpatients. And that that’s been the core of the business for the past couple of years.
Now we’ve turned our attention to see how we can close the loop on that ecosystem of care. So you’re the patient, you go to the hospital and a lot of things happen and you go at home and now you need to be seen by a neurologist. Well, the wait is 6 months and what are you right? If you have more symptoms, you’re going to come right back to the hospital. And so in order to close that loop, we really saw a need, and this is a need that came from our clients for outpatient neurology.
So the question how you pay for it and really the the parity models and the payment models really haven’t caught up to outpatient neurology, the fast tech. Everybody understands the inpatient and some of the exceptions of that that came after the pandemic as a public health emergency have expired or expiring. You know, the last of which is the is, is is the DEA ruling on telehealth, which the kick the the can got kicked down the road for a couple of years and then I’ll look at it again at the end of this year to see what they need to do for that. So things of, you know, the advantages are slowly or disappearing.
And part of the reason for that is it’s just very difficult to understand the value proposition of all these models, whereas it’s pretty easy to understand that in the care of stroke. So turning back to the other models we’re developing now and we’ve developed already and we’ve already been operational outpatient neurology where we have a really good neurology nurse practitioner on ground knowing without the neurologist that’s all the physicians, that’s all the patients would have. They don’t have in some of these areas, they don’t have access to neurologist at all for months now we have, we can get a physician on the screen with a nurse practitioner to see these patients. I care for patients. The model simulates exactly what I was doing as an outpatient neurologist, except that these patients now come back from the hospital, like I said, a week later, not three months.
00:22:42 Tony
Later, right? Right.
00:22:44 Nima
It’s a huge value. Oh.
00:22:45 Tony
It’s big. It’s a very big deal.
00:22:48 Nima
Yeah.
00:22:49 Tony
Well, I think, I think that just circling back a little bit, I, I, I totally agree with you. And I, I, I think really what you’re looking at is a couple of different areas. 1 is, you know, that’s a lot of the traditional thinking about the telemedicine and telehealth. Well, VA got started in it very early. They were probably a pioneer in it, but was more of a geographical thing with VA because they didn’t have the VA hospitals in a lot of areas. So they, they used telehealth as kind of a, you know, some way to that the vet could see a provider without having to drive, you know, 300 miles to a VA clinic.
But what you’re talking about is really a couple things. One is, you know, this kind of just in time telemedicine that that helps out in a situation which in, in this, in the stroke case, it could be a matter of life and death or certainly a matter of, of, you know, a discipline, severe disability or not. Where’s a lot of the thinking has just focused on it as a replacement or a adjunct to a regular office visit where there’s already a relationship between the provider and the patient. You’re what you’re talking about is really that that relationship’s not there, but because of the severity of the situation, you need to act quickly. And this allows you to kind of leverage the technology to be able to do that regardless of the geographical location.
00:24:23 Nima
That’s exactly right. When you think about it, you know, as a provider, because I for quite a while I was also provider of care with telemedicine. I’m the CEO of the company now and you know, now my role is administrated mostly. But when I practised it, it was actually pretty interesting practise.
You know, 11 moment I’m in North Carolina, the next moment I’m in Florida, the next moment in North Dakota. You know, it’s I’m travelling the, the, the United States and seeing patients at the moment of need. It’s unlike anything else. But to your point earlier, central to this is technology. And I think that’s really what’s changed. That’s has been the paradigm shift in medicine is technology and physicians are notoriously slow in adopting technology. You know, we saw this with electronic medical records. Now the the errors are smaller, you know, there there’s just less chance of errors just because of that. There is now you, you can interact with your with your provider on the EMR, you can look up your test results on the EMR, opened up the communication gaps. It’s a lot of good that came with the EMR that became really the centre focus of healthcare paradigm shift. And I think telemedicine has done that for the use cases that it really works very well for.
00:25:43 Tony
Yeah, I, I think so. I, I think one of the, the challenges has of course been the way we pay providers in this country. And I remember at CMS when I was there for years, that was pushed from the telemedicine community to, you know, allow more payment or, or certainly equivalent payments for different types of services that could be provided through telemedicine. And then CMS would push back and some of the members of Congress would also push back because they said, well, we have to see from a budget standpoint, the way the government does budgeting it. It wasn’t showing the return on investment or the certainly the, the the cost benefit analysis was not coming out the way they felt was sufficient. And then, of course, then along came COVID and no one could do a in person visit anyway. So then all of a sudden the value prop rose for that. But I don’t still don’t think that the government has come to grips with this at a level. So if you were, if you were a member of the administration, what would you promote in terms of improving the the role of telehealth, not just for emergency cases like yours, but but in general in terms of payment? I’m talking about in regulations. Huh.
00:27:08 Nima
Yeah, I think that. So there are, while all of this was going on and the licensure waivers were expiring and the parody laws were changing and whatnot, one of the things that I did hear about the limitations that they had was limits on, for instance, on audio only, except for behavioural health. Like that made sense. You know, there are limitations. Those parities, the parity laws were changing. And I know with the pandemic, they kind of lifted the restriction and said fine, you know, only is fine or whatever.
And now it’s going back. So I would say, to answer your question, I would say I would look at the limitations of telemedicine and understand the limitations because you want to have a value prop, but also you want to really be have the ability to increase the scope of telemedicine where it’s needed the most and where it makes sense the most. So for emergencies and it’s not just neurologic emergencies, you know, for all kinds of emergencies that really are short and, and, and specialist and you really need a specialist, you really should open this up. And also for for outpatient follow-ups where we really lack the, the specialist that really need to have that neurologic care is unique in that it’s really not something that primary care physicians can handle the patients afterwards or whatnot. So we really need to to look at specific use cases in the world of specialist where outpatient specialty care makes sense to keep people healthy, keep people out of the hospital, get the cost down.
You know, if I am providing outpatient specialty care and that’s paid for, that payment model is so much less than if I, if that patient doesn’t get to be seen for months and then they go back in with another stroke that gives disability. And again, a lot of the dollars are always have to do with morbidity and mortality and the, and the last last couple of years of life. So when you’re looking at how to save money, you know, for, for, for our budgets, really you got to, it really is focused on getting better care. And part of that is having, you know, the the right parity loss and the right infrastructure for payments for that continuum of care, not just focus on the hyper emergencies. That’s the short answer to that.
00:29:33 Tony
Well, and it’s not really, it really isn’t a short answer because you’re right, it’s it’s not something that’s that’s simple. But I think you pointed out the two areas and I guess if we look at it, you know, what specialties most lend themselves that you got the the front end emergency. But then like you said, the the challenges, I know we have it up here in this area too of seeing a neurologist. It can take, it can take months. And if you’re looking for some post op care, your model seems to offer opportunities that could really make a big difference in people’s recovery.
00:30:14 Nima
Exactly. Yeah, There are quite a few specialties that make ICU care that I think needs to have better coverage, has to have a better payment ICU care Teller ICU is an understandable model. It’s you really do need the specialist to be able to operate in ICU. But unfortunately the payment models really don’t exist all that well. It’s very resource intense and heavy cost in the front end for both the hospitals and also a company that is trying to build a surplus line.
So unless you know, they really improve the reimbursements for that particular one, it it really won’t work very well and there is a very big need for it. You know, the other cases are, you know, Tele, like for cardiology, we can’t do hands on, but there are a lot of things that we can do with telemedicine with cardiology that lends itself very well to to to to the specialist model. And there’s other use cases like that. But I think if we get smart and look at how to operationalize a good use case and really provide value as supposed to just, you know, a blend brush, a general brush and telehealth, and we’re just here to see you on the video and make it work. You know, I think if we get smart about it and we understand the value prop, I think it will go a long way and helping the lawmakers understand, you know, the the value of the scare.
00:31:37 Tony
So CMS has the innovation centre which of course tests different models for potential payment and I don’t know if they I don’t. I haven’t done the research to know how much they’ve done with telemedicine, but it seems to me a lot of what you’re talking about would would make sense to develop the use case and have CMS test the model out in, you know, in model metropolitan areas or metropolitan plus rural areas, wherever it made sense and kind of see what kind of changes they could make they could benefit this type of use of telemedicine. To me, it makes a lot of sense. I mean, but maybe you don’t have a big enough, you don’t have a big enough audience for that.
00:32:25 Nima
Yeah. And I think the one other thing would be that some of these benefits that people have are long term benefits with morbidity and mortality, right? So can we, you know, actually help with morbidity and mortality and help to reduce the cost of healthcare And that may not be very evident in the first month of care. And so, and again, this is a new science, still a new science to CMS and everybody else. So I think we’re in kind of a time period where there’s a lag until how we can really make that happen and and what makes sense. So we will see what happens.
00:33:00 Tony
One of the issues that I know has come up is the whole issue of fraud in, in telemedicine and telehealth. And the HHS Inspector General came out with a number of reports during the pandemic where people were, you know, or, or, or faking locations and patients and, and other types of activities. It seems to me like your, your particular specialty doesn’t lead itself to that because it’s such a matter of life and death what you’re dealing with. But some of the more Dane, more mundane, you know, medical treatments or office visits or whatever would lend themselves more to that. I don’t know what you have in terms of thoughts on the prevention of fraud and.
00:33:49 Nima
Yeah. It’s, you know, I think it has to do a lot with the modality that’s used here. You know, we have physicians that log onto the screen, their IP addresses are registered. We know exactly where they’re at. Nobody’s outside the United States, you know, and we have to build CMS requiring us to build it based on their location of the physician and so on and so forth. So it’s very regulated. It’s impossible to to fake anything or, or so model like this, particularly when there’s a video involved and, and whatnot. I think it’s much easier to avoid the situation like that is, you know, everything is registered. It’s very difficult to fake patients or something like that. However, I think there are a lot of models that go under or categories under telehealth that don’t even require video consultation or audio consultation.
00:34:49 Tony
OK.
00:34:51 Nima
OK, right. So we can you can go right now and order, I don’t know AGLP one medication from a a company on online and ask the questions and never get on a video consultation with anyone. Just, you know, answer the questions online and next thing you know, you have medication. And so Amazon, you know, and there’s a tonne of other people that are doing it in the same model. So now it makes you kind of think, OK, well, nobody really saw me, you know, how did you identify or how did you verify my identity? That varies from company to company, but sometimes these are much more loose. So there are not a lot of regulations on that.
00:35:35 Tony
OK.
00:35:36 Nima
That’s where the lawmakers, you know, right at the so getting nervous like, well, I need to better understand how you’re identifying the patient. Patient is not walking to an office and giving a driver’s licence. You’re looking at and you’re identifying in this little different model. There’s no video consult here, right? So I think those concerns, but the challenge is that telehealth gets under a big umbrella and all these different models of care go under that big umbrella. And so then you have potential for fraud in some of these models. And I think that the the concern is, is, is, is right. I mean there should be a concern with that. So I think what needs to happen is there needs to be a little bit more regulations on the operational aspect of telemedicine, how it’s actually done, what are the safeguards for patient safety and what not. You know, if I am talking to my own physician on telemedicine, my physician knows me and it’s a follow up. I’m just going over some test results. I think that’s a very viable model. However, if I’m seeing someone on the other end for the first time, then that’s a different whole different story. I’m trying to examine him the first time and I can’t do a hands on exam. And if if it’s not very clear who the physician is, where they’re licenced at and where they’re located at, you know, there’s all these questions that need to be answered. And, and the regulation I think is going to be important for the CMS next steps in the law, the lawmakers to feel more comfortable about all the all these issues, including fraud.
00:37:16 Tony
Right, right. Yeah, I, I think it made a good point. I mean, it’s, it’s, it gets lumped in under telemedicine or the larger telehealth, but a lot of it really needs to be looked at kind of more individually to say, OK, let’s talk about the areas where it is most vulnerable and what specialties, you know, are really more vulnerable to that type of fraud.
And, and, and take it from that rather than, you know, painting the whole industry with a broad brush, which you hear a lot about. And a lot of it was, like I said, back to the pandemic, But I, I guess another area just turned into that is the whole area of AI and AI is role in supporting your business models. You mentioned a few moments ago about AI working with your call centres to quickly route calls to the appropriate providers and specialists. And now, you know, we’re moving into more and more types of AI coming out, some of which is has its challenges because it’s based on the data that’s not always been thoroughly vetted.
You also have issues around some of these companies that are moving forward with models that people aren’t fully comfortable with because they think the data is based on certain well, like it may be based on the bigger medical institutions like the Mayo Clinic or Johns Hopkins or things of that sort. So how do you see AI in in your particular area evolving and what safeguards do you put in place to make sure that it works for you and not against you? I guess for a better one of a better way of putting it.
00:39:11 Nima
Yeah, I think when you look at, you know, our business model, you know, I think a lot of people may look at this model and see well, the AI, you know, is going to take over for this and jobs and you know, I wanted to see get robot on the screen. Now it’s so important that I don’t know if that will ever happen in in my lifetime, but but I think what AI has a very big role in in, in our company in the future of our company is a on the back end office kind of a help. For instance, like you mentioned auditing the quality of the calls, you know, AI does a really good job at that and you can really scale that if some, if a caller is calling a call centre, you know, we actually have an audit tool and we can screen every one of the cases and we compare that with what our our managers would audit the cases at and grade the cases at and it’s identical.
So, so the AI also, you know, has a very important tool in our capacity management. Do we have enough physicians at every app or, you know, and all of that. So a lot of the back end office work, I think the AI is going to be very important also with. Collection with visual AI, we can actually get aspects of the, of the screen, what, what we see on the screen and collect the data on that. For instance, when did the patient come to the care?
You know, if we’re kind of doing a focusing on Pi work on, on performance improvement work and you know, the, the patient, they don’t bring the patient to care in good time. We’re going to have delays in administration of the Club Buster medication. So you know the AI can capture that data for us. And so there are a lot of good back end office thing that I think it’s going to be helpful for, but I think that will be the extent of it for us. But I do know if that once we expand the award telehealth and we go to radiology for instance, it’s a very different story there. You know, the artificial intelligence can eventually and we’re on the way very quickly to there read the films and all those models are getting trained right now, read the films where it’s hundreds of films very quickly and probably more accurate than a tired radiologist who’s working days and nights. So that model is going to evolve very quickly.
I think the models of in healthcare, the use cases that have to do with feature recognition like radiology, pathology and dermatology are going to evolve very, very quickly with AI being able to do now you still need the physician to see all of that & off on everything. At the end of the day, the, the AI doesn’t have a liability. The physician has a liability. You know, it’s the physician’s licence at the end of the day, but it will be adjunctive in that you won’t need 100 or 100 radiologists, You’ll need 5 radiologists for that particular location. It it will, it will change the dynamics of healthcare in that way. But you know, obviously a lot of the hands on professions and whatnot and stroke care and all that trauma, sepsis, all these, I don’t think you’re going to be affected with AI in that way, but it will be the adjunctive kind of help that that you’re going to see that will.
00:42:30 Tony
Evolve, right, That makes sense. I guess, I guess one of the things just changing a subject a little bit. It is the role of the patient and the patient understanding the value prop behind a lot of these improvements. You mentioned about the, you know, AI and some of the back end stuff, but the patient, some of this is an education process, not only for the patient, but you have to deal a lot with family and, and, and others when you’re involved in, in the treatment. What do you what do you see as the biggest challenges with that going forward?
00:43:12 Nima
You know, when I started this venture, before I actually got behind the camera and saw patients, I was thinking there’s going to be a lot of resistance on patients. Well, you know, why am I seeing a physician in my camera? You know, why can’t I see a real physician and so on and so forth. But what I actually, my experience was quite the opposite. My experience was that when I get on the screen, start seeing the patients, the whole telemedicine thing goes away and I’m get so involved with the patient and the patient gets so involved with me. It’s almost the opposite of what happens right now in in healthcare. You know, right now when you go to your physician in the office, what is your physician doing? The typing and looking at the computer then, whereas in the world of telehealth is actually is ironic because it is computer based.
It’s ironic, but the attention is 100% the patient and you. We are so worried about what’s going on with the patient and the patient is so worried about seeing the physician right away. When they see this, they’re like, wow, you know, this actually works. Now I’ll share with you the pandemic also brought a very clear understanding to everybody what telemedicine is. But when there’s actually see, there is a, a sub specialist physician that logs on from somewhere else and there’s a stroke specialist that brings it just for you, there is a component of comfort.
And I all these years of doing this, you know, I didn’t, I thought I understood it all, but I didn’t fully understand it until I was on the other side. You know, when my dad got ill and, and he got a symptoms of stroke, we had to go to the hospital. I saw him in the field, ambulance came, took him. So I got to the hospital, which would be the mimic of me getting to the hospital, you know, from as a physician to see a patient. Took me a while to get to the hospital, but I got to the hospital as a patient’s family.
And when I got there it they took me to bedside. They knew I was a physician, so they took me right away. And by the time I got to bedside, he he was already been seen by the neurologist. The ER doctor was there, the nurse was there. I mean, there was just, it was coordinated the first time I actually saw it on the other side coordinated so well. And I was like, wow, in the old days this would have never happened, right? So patients as a family, I come in and I see this, I’m like, wow, like there are a lot of people around this. There’s a specialist there and there are people are doing all these things and they’re taking care of him in such a good time. I feel very comfortable.
So if it was me, I would definitely want that. I wouldn’t want to go to a hospital and have them call somebody in and God knows how long it takes while I’m having symptoms of stroke. So patients actually react very well to this. There’s very, very few times where we see that patients resist the use of telemedicine, especially after the pandemic really has changed. Now moving forward, I think we will see how the IT, it has to do with the patient’s journey and their perspective in the value stream, right?
If the AI is helping and whatever we do with technology is helping to facilitate the care, but at the, at the end of the day, there is a patient physician interaction, there is that rapport and patients feel comfortable with it, then I think it’s going to be successful. We just have to make sure we understand where the limitations are and and how we focus on the value stream of the patient. I always go back to patients and value stream, how you can create value for patients and that can be the focus of everything that we do as a society.
00:46:52 Tony
Yeah, I, I agree with you. I, I found that doing the visits myself, I mean, it’s a lot more relaxing than going into the doctor’s office because you have to deal with a lot of different people. And and of course I won’t even talk about ER, I mean, that’s, that’s a whole nother animal in and of itself. So I, I, I think part of it is just as they get more familiar with it, I think the pandemic helped a lot, but I think they’re still seeing it in a fairly siloed way. So if they, if they got more knowledge of some of the stuff that you let people like yourself are doing, I think that that would, that could make a big difference in broadening people’s thinking about the telemedicine in a different ways. It could be used from a patient patient experience standpoint.
00:47:36 Nima
Yeah, and some things are are much easier to understand than others. And one example is psychiatry. You know, nobody wants to wait in a waiting room in a psychiatric in office office, whereas you can at the comfort of your home, you can talk to a psychiatry, you know, in video. They don’t need to examine it, put hands on you. I mean, that’s so well understood that I think that most of the psychiatric offices now are doing telemedicine. You’re reduce your cost. You don’t have the cost of the brick and mortar. Everybody wants it, patients want it, their providers want it. Then then you can expand your care to providers that are not necessarily in your area. So I think that’s just going to get more and more with psychiatry. Just makes a lot of sense.
00:48:21 Tony
Oh, absolutely. I’ve got family members who who use it and they, it’s, they love it. It’s, it’s so it’s so much more comfortable for them and it makes a big difference in terms of health, how comfortable, but also how you know just how in tune they feel with it as opposed to sitting in the office and wonder if anybody else sees you in the office or just the whole experience of that is it’s, it’s, it’s totally set up for that. So one, one last question before we move towards the final is the whole area of rural hospitals and rural health. Sometimes you have a problem with broadband in those areas. A lot of hospitals are closing. I think it’s it’s an area that really cries out for greater use of telemedicine, but the infrastructure there is can be challenging. If you, I’m sure you’ve dealt a lot with that, what are some of the thoughts that you have?
00:49:21 Nima
Yeah, I, I, I absolutely agree. I mean the, the absence of technology, absence of broadband in some of these areas, access of the right people that can do it, access of funding, you know, the business model doesn’t make sense for funding. It is small. You know, I can put a, you know, a cart in, in a rural health in the hospital that may have 9 strugglers a year. And so from a business standpoint, if I were to, you know, charge that hospital a fixed fee, that hospital won’t be able to afford it because they don’t have enough cases. And if I were to charge them a variable fee only per house per case, well, when you think about it, I have so much more overhead to bury that. And so the business model just kind of falls apart unless there is good payment structure and or unless that model gets absorbed into a bigger system. Now the system can then absorb the cost and allocate cost of different costs. And that but that’s a challenge that unless the government steps in and helps these guys. I mean, you know, I’ve been to hospitals where they don’t even have a, a clear cut ambulances or they don’t even have staff like nurses. And when there’s an emergency, they call out to the community, people come in and help. I mean, that does exist. It’s, it’s, it’s, it’s a major issue. And, and really the government, I think we talked about earlier what the government really needs to step in and I think they’re all health will be a top of the list there.
00:50:54 Tony
Yeah. And I think tied into that too is the whole issue of a disaster response and because then your infrastructure is down. And we saw with Helena in North Carolina, up in those mountainous areas, I mean, it was a disaster from a healthcare perspective, but there wasn’t, they didn’t have the providers there. They didn’t have the facilities. And of course the broadband wasn’t available even it was available in some of those areas like Asheville. It was shut down because of the disaster. So that is another kind of a tight end area that needs, you know, the government to really take a stronger look at that and how it can be supported.
00:51:36 Nima
Yeah, we were actually, we have a big system in Nashville that we’re serving in it. And at the time this happened, they were able to get their system up in that hospital, the big hospital that the obligation and mission and we were able to service them. But obviously their physicians going to get in. You know, they’re really, I mean all of a sudden they were had a huge need. We were already active there, but they had a huge need to expand the services for telemedicine there. And if it wasn’t for telemedicine, those people wouldn’t have gotten the care for sure. This is a very big problem. Maybe we’re going to have the Hurricanes and earthquakes and all of this. Those are not going away. And then the other disaster that’s not a natural disaster is cyber attacks.
00:52:19 Tony
Right. Oh yeah.
00:52:22 Nima
So.
00:52:23 Tony
Yeah. That’s another issue that we could spend a lot of time talking about that. But you’re right, it’s any, any of these risk points, whether it be geographically determined or cyber or just the, you know, the natural disasters that occur, any of that stuff is a is a risk point that has to be looked at. But telemedicine in in many ways if you can get part of the infrastructure up can be be helpful even if you can’t get the the all the providers to be able to come in.
00:52:58 Nima
Yeah, exactly.
00:52:59 Tony
Exactly. All right. Well, Neiman, we’ve talked about a lot of things over the last 45 minutes and I just want to turn to a couple questions a little different than the the subject 1 is what keeps you busy when you’re when you’re not tied up with this area, What do you do for fun?
00:53:19 Nima
You know, for fun outside of whatever I do with my kids for a grown up right now. But they’re always for kids.
00:53:25 Tony
Oh yeah.
00:53:27 Nima
Is Wellness and fitness and I’m a big fan of fitness It’s you know, when I go to gym or I exercise, I’m meditating, I’m thinking of nothing but but the exercise and for me it’s the exercise of the mind and the body and keeping healthy. I mean, I’ve, I’ve, you know, as, as you pass a certain age and in your professional life, in your personal life, you really start to understand that life is finite and, and you want to do what you can to stay healthy and that your, your perspective will change. And you know, I’m right now, I’m living now the, the life of, of living well and healthy and, and eating well and exercising and that, and I, and that’s my hobby. You know, it’s, it’s been a great hobby and I’ve really enjoyed changing my life in the past couple of years in that way.
00:54:21 Tony
Yeah, I agree with you. I, I do a lot of that myself as well. And it does, it makes a big difference in your life, both from a physical standpoint, but also from a mental health and an emotional health standpoint. It really makes a big difference. So it’s excellent. So if people want to find out more about what we’ve been talking about, are there certain websites or podcasts or other things that you recommend that they go to to get additional information? Because a lot of what you’re talking about, I don’t think many people have the understanding that while we spend a lot of time talking about that. So where would you recommend people go to to get more information?
00:55:05 Nima
Yeah, that’s a good question. So in terms of I think one of the resources that I found very helpful for source of information is the ATA American Telemedicine Association. It it did a lot of information there that gets updated on an ongoing basis, including the the parity laws and, and, and, and all of that, that movement that’s very fluid right now. And then you know, you know, obviously if, if people want to find out what we do and what telemedicine is and what not, we’re at tstelemed.com and we’re the largest of the providers in telen neurology across the United States. So we see the largest number of patients in telen neurology until the stroke. So if, if, if there are times where people have questions and what not, they go on that side and they fill up the questionnaire and you know, they can put their names and all that. And we get back to them with questions that they have about all this, that you know, I would provide that as as a resource. And for myself, you know, there’s, there’s various different resources that I personally use for understanding the current policy making and what not. But really the the best one of them is the is the is the ATAII would say that for neurology, you know, and then I’m not going to get into the publications and the scientific aspect, but that’s that’s what I would say.
00:56:36 Tony
OK, great. So just a couple final questions and you don’t have to go into a lot of detail that, but but what in the in the healthcare space has been most surprising and and beneficial to you over the last five to 10 years? I mean, what, what do you see from your perspective? What’s the best thing that’s happened?
00:57:03 Nima
Well, in the last five to 10 years, I will have two answers for this.
00:57:10 Tony
OK.
00:57:12 Nima
Well, telemedicine, OK.
00:57:15 Tony
I kind of figured you’d say that.
00:57:16 Nima
Yeah, that would be the obvious, right? And then the other answer would be what is the best and the worst thing that happened to humanity, I think is a pandemic. In some ways it has changed the paradigm of how we think about life and it I think a lot of people focus on the on the negatives of the the obvious things that are very negative about the pandemic. But when you kind of look at the bigger picture, there are some things that came out of it that changed humanity, maybe for the better even.
And so I think, and one of those is how people think about healthcare. I think there needs to be a, and there is a trend and there needs to be more of a trend of a focus of patients caring about their health and about their Wellness and preventative care. And when people start to get sick and the pandemic came out and the need for telemedicine, the need for healthcare came out, the value of healthcare was elevated. And I think that’s one of the the take home messages. It would be that, you know, if we don’t take care of ourselves, it’s going to catch up to us. Living a healthy life is really where it all starts. And when we start to see, you know, we’re, we’ve now seen 1.6 million patients now in our venture, you start to see patients with stroke after stroke and the morbidity and immortalities. And it’s very gratifying to be able to help patients. But you know what, you know, they, they, there is a better way of preventing disease and Wellness. And I think that’s really what I would like to see, the ongoing change.
00:58:53 Tony
Right, right. Well, thank you name. I appreciate this. Been a great conversation and best of luck to you on your ventures.
00:59:01 Nima
Thank you very much. It was a pleasure. It was nice talking to you.
