AcuteCare Telemedicine Blog


Eagle Scout, AcuteCare CEO Dr. Matthews Gwynn Does His Best To Help Others

Being a good scout has carried Dr. Matthews W. Gwynn through life, to the post of chief executive officer of AcuteCare Telemedicine, and consistently as one of America’s Top Doctors, according to U.S. News and World Report.

An Eagle Scout’s life lessons are a solid foundation for Dr. Gwynn, now 55, as he strives, on his honor, to do his best to help others. “It teaches you to do the right thing if you take it seriously,” he says of Scouting’s influence.  “In my blood I always try to do the right thing. I believe there is something to be said for society that, if you simply follow the Scout law and motto and think like that, it sounds hokey, really hokey, but the world is a better place.”

Dr. Gwynn was born in Baltimore, Md., then moved around in his early years, to Cincinnati, Ohio, Raleigh, N.C., and Reston, Va.

With his father’s encouragement, he grew into the idea of becoming a doctor. As a chemistry major with a liberal arts education, it was his love of science and problem solving, plus his maternal grandmother, that cleared the path for Dr. Gwynn’s career. In his teenage years, he helped take care of his grandmother after she’d suffered a stroke. “I came to understand the frailties of people,” he remembers. “I realized I could make a living at it and also help people get better.”

He is a graduate of the College of William and Mary and the University of Virginia Medical School. He completed an Internal Medicine residency at the University of Alabama in Birmingham, and then returned to the University of Virginia for his Neurology residency. He is also a partner in Atlanta Neurology.

The challenges and riddles of Neurology are what eventually drew Dr. Gwynn in. “I loved the fact that it was a puzzle and the diseases were highly interesting and very challenging,” he says. “Not particularly easy and not everybody could do it. It required a very formal thought process to come to the right answer.” He says he was discouraged at first, “that there was nothing to do for people” he adds. “It was the old saying ‘diagnose and adios’ in neurology.” So he went into general medicine residency to find something to help people get better. But he changed his mind and realized he was fascinated by Neurology, just as the field was developing quickly.

Dr. Gwynn realized that telemedicine was a rising frontier in the field of Neurology. “The current economics in medicine is unfavorable for many neurologists to stay in hospitals. Almost all liability comes from there, and it is very disruptive to your primary income source, which is your private practice,” he says.  This exodus creates a real void. “Telemedicine is not a fad. It’s a demand that is growing,” the chief of Neurology at St. Joseph’s Hospital in Atlanta adds. “We are trying to use this opportunity to fill the gap.”

The CEO sees the professionals at AcuteCare Telemedicine as “competent, punctual and engaging.” He says they embody the “Three A’s of Medicine”: ability; availability; and affability. “They are competent and have a wide breadth of clinical neurology experience and knowledge and are leaders in their field,” Dr. Gwynn adds. “They are engaged. We are people-people. We provide expert advice and with patients we are able to empathize and help them really well; better than most of our colleagues.”

Dr. Gwynn is also director and founder of the Stroke Center of Northside Hospital and recent chairman of the Department of Internal Medicine. He says the ability to connect with people is crucial in telemedicine. “It’s amazing how well that works,” he says. “Within five seconds I can gain the trust of the patient as much as if I were in the room by greeting them with a smiling face and respect.

We all find commonality very quickly with our patients,” the husband of 27 years and father of two says assuringly. “A lot of people are very frightened when they have neurological symptoms, because it is so foreign to them. It’s an enigma. So we’re there to try to put them at ease and figure out how to help them.”

Dr. Gwynn has also become a national expert leader in using botulinum toxin for medical treatment of chronic migraine, movement disorders, spasticity, and other disorders, and he trains other physicians to use it in their own practices.

The doctor enjoys a round of golf in what little spare time he gets. He also likes to cycle and backpack and enjoys classical music.

The Eagle Scout in a white coat gets his inspiration within each new day. “I love that every day is different and that I am going to see interesting people,” Dr. Gwynn says. “That people are going to come to me asking for my advice and wanting me to help them and make them better. I can’t help everybody but I can listen to everybody and ameliorate their suffering.”

He is also fond of the direction AcuteCare Telemedicine is taking. “By the end of next month we’re going to be in six states and many different ERs,” Dr. Gwynn says, “and I can reach anyone from anywhere. I can even have an influence on someone’s care 2,000 miles away in Arizona. That’s very cool.”



Employer Sponsored Telemedicine Programs On The Rise

A new survey by Towers Watson, a global professional services company, reveals that telemedicine could provide billions in healthcare savings each year as employer-sponsored telemedicine programs increase. The availability of telemedicine represents significant cost savings for employers by precluding lost time and productivity as workers must go off-site for office and face-to-face care. The savings for employees with such convenience should also not be overlooked.

“While this analysis highlights a maximum potential savings, even a significantly lower level of use could generate hundreds of millions of dollars in savings,” said Dr. Allan Khoury, a senior consultant at Towers Watson. “Achieving this savings requires a shift in patient and physician mindsets, health plan willingness to integrate and reimburse such services, and regulatory support in all states.”

The results of the study are not surprising to many of those who have been advocating an aggressive expansion of telemedical technology in order to address rising healthcare costs, expand access to medical specialists for rural patients and to head-off a predicted physician shortage. As patients and caregivers become more familiar with how and when new communication technologies can improve the delivery of medical care for a significant number of medical services, the reluctance associated with foregoing face-to-face encounters with the family doctor and replacing it with a virtual experience is beginning to fade. Patients who need ordinary medical treatment and consultations are gaining significant cost and convenience benefits with the new relationships. Once patients become familiar with the virtual experience, the vast majority are responding very favorably.

Insurance providers and employers are also joining the chorus of support. The Towers Watson findings indicate that 37 percent of those employers surveyed expect to offer their employees a telemedicine alternative to traditional in-office or emergency room healthcare by the end of next year. It’s an increase of 15 percent of employers who currently offer their employees such options. The move by employees to utilize the employer telemedicine programs is progressing at a slow pace however, with only 10 percent of those eligible taking advantage of the opportunity.

As the benefits and availability of telemedicine and telehealth services grow, the numbers who choose to participate is expected to rise.  “With both insurance companies and employers encouraging its use, telemedicine is going to have a growing role in the spectrum of health care service delivery,” Dr. Khoury says.

 

 

 



Dr. James Kiely Honored To Be Entrusted With Offering Guidance And Care

Dr. James M. Kiely characterizes his AcuteCare Telemedicine team as personable, professional, expert, engaged, and available.

“People feel they are buying hardware when they engage in telemedicine,” says the neurologist originally from Peoria, Ill., and raised in Naples, Fla. Dr. Kiely has been named one of America’s top doctors by U.S. News and World Report in recent years. “They think that (telemedicine) is just an app and they are gonna have this faceless, personless, characterless interaction. When you engage with AcuteCare Telemedicine you are engaging in a staffing solution,” Dr. Kiely adds. “You are gaining quality individuals to join your medical staff and your patients are going to be engaging with individuals with whom they can relate on a personal level who are invested in their care.”

Dr. Kiely’s own investment in medical care took flight after graduating with honors from the University of Florida. He still follows his beloved Gators. He received his M.D. from Emory University and Ph.D. from the Emory Department of Pharmacology. He completed his neurology residency at the University of Virginia and has been a partner of Atlanta Neurology since 2000.  In 2009, he became a founding member of AcuteCare Telemedcine.

It is the duality of the mind and brain that drew Dr. Kiely to neurology. “The idea that this was at once an organ and at the same time it is where we manifest ourselves,” the father of four says. “There is no disease that affects the brain without affecting who that person is,” he adds. “It affects their actual sense of self.”

AcuteCare Telemedicine was created, Dr. Kiely says, to guide and significantly impact the well-being of patients with a sudden catastrophic event who otherwise wouldn’t have swift access to vital expertise.

Dr. Kiely is pleased at telemedicine’s high level of patient and family acceptance. “To be able to come in and affect somebody in this way at the time of their most crucial need is undeniably a very personal experience for the patient and the physician,” he says. “Using technology you can still go to the bedside and look around the room. It really is a very personal encounter and I have yet to have a patient or family, when asked, say they’d rather not be treated this way.”

The doctor’s Irish Catholic descent drives him to go to work, do his job, and share his talent. He derives inspiration from patients and their caregivers. “Faced with life-changing, even life-ending circumstances they make difficult decisions and endure daily challenges I have never personally had to,” Dr. Kiely says. “It is an honor to be trusted with providing counsel and guidance.”

Examples of the life-saving impact of telemedicine come easily from Dr. Kiely. He tells of a call suggesting a patient was exhibiting stroke symptoms. The ER physician sought advice regarding treatment with tPA, the clotbusting stroke drug. But when Dr. Kiely went online, it turned out to be something else. “Once I ‘beamed in,’ spent time in the room with the patient and had a conversation with his wife, it became apparent that he needed an acute, urgent intervention for stopping seizure, not for treating a stroke,” he says. The patient was having subtle seizures that mimicked the appearance of a stroke.

Amid the technology that enables telemedicine, the concept revives a method of care from days gone by, when doctors actually made housecalls.

“Everything old is new again,” Dr. Kiely says. “It wasn’t until after World War II and an increase in specialists and hospitals, that patients were brought to the doctors. We’re still using doctors’ offices and hospitals as a setting for care, but it won’t be long before patients routinely see physicians in their offices and homes. You may keep a child home from school, and have the physician see the child there or at the school.”

When Dr. Kiely isn’t making long-distance housecalls, he enjoys exercising, movies and hanging out with family and his wife of 27 years. He misses having the time to relax with brewing and gardening.

Fishing is not among his off-hours hobbies, but is his analogy for his work at AcuteCare. He doesn’t need fishing, stating he gets enough hours of contemplation interspersed with minutes of intense action at work. “You are gonna go out there. You have no idea what your day may hold, but you know it’s gonna be worthwhile,” Dr. Kiely reflects, connecting hook and line, with his healthcare duties. “It’s gonna be exciting. You’re gonna make a difference. You’re gonna have some fun. There is nothing routine about it.”



Another Attempt To Expand Medicare Coverage For Telemedicine

Two members of the U.S. House of Representatives are not giving up on expanding Medicare coverage for telemedical services.

In 2012, Glenn Thompson (R-Pennsylvania) introduced legislation amending Title VIII of the Social Security Act with sweeping changes that would allow Medicare payment coverage for nearly all telemedicine services where the corresponding in-person treatment would be covered. That aggressive legislation died in committee, but Glenn is back and has added Rep. Mike Thompson (D-California) as co-sponsor of the Medicare Telehealth Parity Act of 2014. The new bill is less aggressive and seeks to phase-in telemedicine coverage over a four-year period. The phase-in term will allow for measuring the effectiveness of the new coverage and an opportunity for Health and Human Services (HHS) to develop standards for remote patient monitoring and other potential telemedical care.

Current Medicare rules only permit reimbursements for telemedicine services to patients who reside in designated rural areas that are beyond the reach of comprehensive urban healthcare centers. Some critics have complained that the current rules are arbitrary and create situations for some Medicare patients and physicians which restrict access to needed care simply based upon where a patient lives. The new legislation calls for expanded telemedicine coverage in urban areas with a population of 50,000 people or less, and would expand the acceptable care sites from hospitals and doctors’ offices to include retail clinics as well.

Two years after enacting the new bill, coverage would expand to urban areas with a population between 50,000 and 100,000, and would add home telehealth to the acceptable care sites. Also, outpatient services like speech therapy and physical therapy would be added as a covered category for reimbursable telehealth services.

After four years, telemedicine would become reimbursable everywhere, under the provisions of the Act. Medical care provided by phone or email alone would not be covered.  After the second year the legislation requires the United States comptroller to conduct a study to determine the efficacy and potential savings to Medicare from telemedicine.

Often for very legitimate reasons changes in well-established government sponsored programs do not seem to come about quickly, but this new bill provides the opportunity “to test the water,” evaluate the ongoing progress and allows for adjustments along the way to insure its effectiveness. It is also encouraging that the legislation has bi-partisan sponsorship and support. Perhaps it is time another barrier to telemedicine’s benefits be set aside in the interest of patients and the doctors and caregivers dedicated to delivering their care.



Telemedicine Delivering Advanced Pediatric Care To The World’s Children

Telemedicine was originally trumpeted as a technological tool capable of delivering specialized medical care and treatment to patients living in rural areas of America. But the technology, which helped connect stroke patients, diabetics and the chronically ill to medical specialists located at urban medical centers, is now helping to effectively deliver quality specialized healthcare to children all around the world.

Doctors in Latin America believe that telemedicine has improved the outcomes for young patients in those countries. A new study just released by researchers at Children’s Hospital of Pittsburgh (Children’s) at UPMC has shown that physicians in Latin American countries were very satisfied with services offered by Children’s. The results were gleaned from more than 1,000 pediatric consultations between physicians at CHP and doctors in Latin America.

“We know that telemedicine-assisted pediatric cardiac critical care is technologically and logistically feasible in the international arena,” said Ricardo A. Muñoz, M.D., FAAP, FCCM, FACC, of Children’s Hospital. He is chief of the Cardiac Intensive Care Division and led the study. “And now we know that the physicians we assist internationally consider this technology to be useful for patient outcomes and education.” But Pittsburgh is not the only city reaching out to the world’s children.

The Cincinnati Children’s Hospital Medical Center, in Ohio, has a new telemedicine program that is diagnosing and treating sick children located in the Dominican Republic, using virtual technology. Physicians at the Center for Telehealth at Cincinnati Children’s are able to share medical information about patients, video and audio without the costly and inconvenient aspects of long-distance travel. Specialists in pediatric cardiology, neurology, psychiatry, cancer, blood disease and urology are available in Cincinnati for international consultation.

Physicians and patients in the country of Ukraine are connecting with specialists and subspecialists at the Miami Children’s Hospital’s (MCH), through telemedical technology, for individualized medical consultations, electrocardiograms, ultrasound, endoscopy and audiology exams and treatment. Through their partnership with Ukraine-based Boris Clinic, the MCH program is helping support the treatment of Ukrainian children.

Even when children are sailing on the Seas of the world, telemedicine is ensuring that the best in medical care is not far away. MSC Cruises is initiating new technology across its entire fleet of passenger ships to enable the long distance care of children with onshore support from specialists located at The Giannina Gaslini Institute in Genoa, Italy. The world-class pediatric medical center will enable onboard doctors to confirm their diagnoses and treatments using a cutting-edge system of remote image and data transmission. Virtual consultations with pediatric specialists, radiology and health monitoring will be available to the ship’s young passengers 24/7.

In the past, providing quality medical care to sick children living in hard-to-reach areas of the world required extensive travel and complicated logistical solutions for caregivers and patients alike. Technology, especially telemedicine, is rapidly improving the delivery of quality medical care to children living not only in rural America but throughout the world.

 

 



Patients May Get A Dose Of Regulations When Reaching For Telehealth
July 24, 2014, 9:14 am
Filed under: Industry Standards, Telemedicine | Tags: , , ,

John Williams was feeling poorly after a long day of meetings with clients. He had traveled to Los Angeles for a series of presentations for a prospective client and was scheduled to meet with the decision-makers the following day. It was vital that he be at the top of his game, but he was feeling terrible and knew that he needed to see a doctor.

His customary sinus infection was keeping him from preparing for the important meetings.  Away from home, and after regular business hours, John decided to try a new service the hotel bellman had told him about. It would connect him with a doctor via a smartphone application. After downloading the app, John was connected with a board-certified doctor. Fifteen minutes after that, he had a prescription to address his troublesome symptoms and a list of things he could do to help fight-off future infections. He readily paid the $40 fee for the service and went on to complete his mission successfully the following day.

John’s story is becoming more common throughout the country as consumers look for more convenient appointments with healthcare providers. For a relatively reasonable fee, patients are connecting with a licensed physician via their tablet or computer when they are unable to see a doctor through more traditional methods.

The most common treatments available through telehealth include routine respiratory illness, fever, ear and urinary tract infections and skin or eye problems. In many states across the country consumers and physicians alike are enthusiastically embracing telemedicine when it comes to routine medical consultation and treatment for patients that don’t require intensive medical intervention. Online medical exams promise to be more convenient, lower-cost, and are generally offered for a fixed price. But perhaps more importantly, for many time-strapped patients, the usual long wait at a primary-care office or busy emergency room is avoided. The virtual experience is being offered in many states that have established telemedicine rules supportive of expanded virtual healthcare services.

Rules recently proposed by the Federation of State Medical Boards (FSMB) and several state legislatures are likely to hinder the expansion of virtual doctor-patient relationships, like John’s. While the FSMB guidelines simply require that the same standard of care for both in-person and telemedicine services be met for the formation of a valid patient-physician relationship, the proposed regulations in Tennessee will require that a patient-physician face-to-face meeting take place prior to the first virtual experience. Furthermore, additional in-person doctor-patient appointments are required at regular intervals in order to continue future telehealth encounters. While the need for such rules may be founded in legitimate concerns for patient safety, the practicality of such state-by-state restrictions is being debated.

In an era where state boundaries are being blurred by a push toward a more consistent and accessible national healthcare delivery model, consumers are eager to utilize their electronic devices, even for maintaining and monitoring their healthcare. It seems unlikely that restrictive rules, like those contemplated by Tennessee officials, will be able to stand the test of consumers looking for better access and more convenient and cost effective healthcare services offered through telecommunication technology, particularly when such unrestricted access may routinely be available in an adjacent state.

It may be too late for prudent and well-meaning state legislatures and bureaucracies to impose their rules on the new healthcare delivery model.  The more consumers recognize the choices and benefits virtual healthcare has to offer them, the more they are likely to exercise their influence over the regulatory process. Severely restricting or over-regulating virtual healthcare will be like putting the genie back in the bottle.

 



Telehealth Takes Important Care To Veterans Through The VA

Even before the recent revelations of the administrative follies at the Veterans Administration (VA), it was common for each of us to know of a veteran seeking medical attention from a VA Hospital. Usually the discussion centered on the time it took the patient to travel to the nearest VA Medical Center, particularly for those patients living in more rural communities many miles from the urban centers where most VA facilities are located. It was even more difficult for those veterans who needed specialized care from a consolidated, regional VA Center located many more miles from their home, often one or more states away.

Despite today’s plethora of negative information coming from the embattled Veterans Administration, it appears that someone at the organization was doing something right in order to bring better and more accessible healthcare to our nation’s military veterans via telecommunication technology. The VA System seemed the perfect proving ground for implementing telemedicine on a larger scale. With patients scattered far and wide, doctors and caregivers were able to connect virtually with VA patients no matter how far they were from the hospital.

A recent review of the telehealth services initiatives at the VA indicates that more than 600,000 veteran patients received some element of their health care via telehealth in 2013. The patients represented 11 percent of the veterans in the VA health care system who participated in 1.7 million telehealth episodes of care. According to Dr. Adam Darkins, “telehealth in VA is the forerunner of a wider vision, one in which the relationship between patients and the healthcare system will dramatically change with the full realization of the ‘connected patient’. The high levels of patient satisfaction with telehealth and positive clinical outcome, attest to this direction being the right one.”

Forty-five percent of the patients live in rural areas, limiting their access to VA healthcare. The number of veterans receiving care via VA telehealth services is growing approximately 22 percent a year. Telemental Health is one of the leading specialties provided through telecommunication. The VA has delivered 1.1 million patient encounters through 729 community based outpatient clinics since 2003 and in 2013 the VA delivered 278,000 Telemental Health encounters to 91,000 patients.

The use of TeleDermatology is up by 279 percent from its inception, treating more than 45,000 veterans. New programs under development include TelePathology, TeleWound care, TeleSpirometry and TeleCardiology. Dr. Darkins says, “Telehealth is often described as helping provide the right care in the right place at the right time, which translates into many veterans receiving care in their own home and local community. In doing so, telehealth often avoids the need to travel, but can also alert the VA that a patient needs to be rapidly seen in the clinic or hospital.

Based on this report, the agency’s telehealth initiatives are positively impacting veterans by providing quality and accessible care.




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