AcuteCare Telemedicine Blog


Does The FSMB ‘Compact’ Go Far Enough?

A new bill was introduced to Congress earlier this month that is designed to remove what many are calling a significant barrier to the expansion of telemedical services throughout the US. The “Telemedicine for Medicare Act,” or HR 3077, was introduced Sept. 10, in the House by Reps. Devin Nunes, R-Calif., and Frank Pallone, D-N.J.

In introducing the bill, Rep. Nunes said, “By reducing bureaucratic and legal barriers between Medicare patients and their doctors, it expands medical access and choice for America’s seniors and the disabled.” For doctors who treat Medicare patients, the bill will remove the state-by-state licensing requirement which has existed since the very formation of the states. Presently, each state requires a physician to be licensed in the state where the medical care is being performed, making it difficult and unnecessarily expensive for doctors to practice telemedicine across state lines.

“Keeping medical licensure within the states’ domain maximizes surveillance of physician quality while fostering diversity by preventing potentially unreasonable control by Federal agencies,” says AcuteCare Telemedicine Chief Executive Officer Matthews Gwynn, M.D. “The efforts by regional state groups to streamline licensure is a good solution.”

Joel White, the Health IT Now coalition executive director says, “Congress has already had success in implementing a national telemedicine framework for members of the Department of Defense (DOD) and Veterans Administration (VA), this Nunes-Pallone bill does the same thing for Medicare beneficiaries.”

As if taking a cue from the bill sponsoring congressmen, the Federation of State Medical Boards (FSMB) has just released model legislation which would create a multistate “compact” system, where member states will experience a streamlined interstate licensing process. While the proposed compact promises to expedite the path to individual licensing requirements within those member states, it appears that it will not sufficiently address the costs associated with fees charged for each license or with the process as a whole in non-member states. The model legislation calls for at least seven states to participate in the compact.

Many industry leaders feel that if more states sign-on to the compact it will head-off the federalization of medical licensing. But at first read, the FSMB compact model would complement many of the same negative, bureaucratic, bells, whistles and hoops that would most likely come with a national licensing system, leading others to see the proposed FSMB legislation as a means to preserve the centuries-old influence of state medical boards’ authority over the authorizing of physicians’ practices.

With the Congress already demonstrating a respectable performance in providing a successful framework for telemedicine to flourish, through the DOD and the VA, the present actions and efforts by FSMB and their supporters to bring the entrenched state licensing process into the 21st century, and avoid federal intervention, may be an example of too little, too late.



Universally Consistent Telemedicine Guidelines Still Out Of Reach

Recognizing the strong growth and innovative approach in telemedicine practices, the American Medical Association (AMA) enacted a set of guidelines for care provided by telecommunications earlier this year. The guiding principles seek to address the concerns and issues within the medical community relative to the development and implementation of telemedicine programs. The AMA guidelines support the “use of telecommunications in the delivery of healthcare while ensuring favorable standards of care; patient safety; quality and continuity of care; transparency; and the responsible handling of patient medical records and privacy.”

The action by the AMA appears to address the many valid concerns among the medical community while providing much needed flexibility, if telemedicine is to fulfill its many promises to increase availability of specialized medical services to rural communities, reduce costs of medical care and have a positive impact on the anticipated future shortage of physicians.

More recently, the Georgia Composite Medical Board enacted a new regulation governing the standards for telemedicine practice for physicians practicing in the state of Georgia. Much like the AMA guidelines, the regulations establish consistent standards of practice for providing treatment and consultation through the use of telecommunication technologies. The regulations were enacted after more than two years of evaluation and discussions by the state Board. The requirements, like those of the AMA, appear to successfully address many of the same concerns and issues.

The Georgia regulations require that all providers of telemedicine services, which include physicians, physician assistants (PAs) and advanced practice registered nurses (APRNs), hold a valid Georgia state license. However, one area of inconsistency between other proposed individual states requirements and the AMA guidelines is the requirement relative to prior in-person examination.

The AMA prefers not to specify whether the prior face-to-face examination requirement, before rendering treatment via telecommunication, must be performed in person or by a video encounter. The Georgia regulation specifically requires an in-person relationship prior to the any telemedicine service, but enumerates several exceptions and qualifiers which defer the requirement in specific instances. In many other states, including Tennessee, a much more defined requirement of pre-telemedical care relationship is mandated.

Perhaps the most prevalent impact of technology on our society is its effect on breaking down pre-existing divisions, both geographical and social. State lines, geographic hurdles and physical market limiting factors are obliterated by advances in telecommunications. If the full benefits of telemedicine are to be realized, consistency and clarity in regulations and guidelines must prevail.

Few in the healthcare community advocate for blanket federalization of regulations. The industry can do more to enact a core set of standards and practices that successfully address the bulk of concerns and issues of each entity while assuring every patient, regardless of where they reside, receives the best quality and most efficient medical care available.



Dr. Lisa Johnston, as CFO, finds AcuteCare experience to be priceless

Knowing how to analyze, organize and execute made her a star point guard on her undefeated high school basketball team, on Long Island, N.Y.

Those same qualities now in her professional life enable Lisa H. Johnston, M.D., to shine as the chief financial officer and founding partner of AcuteCare Telemedicine.

From Queens, N.Y., originally, it was at a young age that she decided to become a doctor. “I remember going to see my doctor at his house and thought, ‘Wow, he gets to work at home and make sick people feel better’,” Dr. Johnston says. “I remember looking through encyclopedias to figure out how old I would be when I graduated from medical school. Funny how it was so old then and so young now,” she laughs.

Initially, she wanted to become a physiatrist, but studying Neurology as an elective caused her to change course. “I remember seeing a man in a wheelchair whose left arm kept hanging out of the chair. I thought, ‘doesn’t he know it’s getting caught in the spokes,’” Johnston says, “and the resident said, ‘he had a stroke in his right parietal lobe. He has neglect and doesn’t know that’s HIS left arm.’ And that was it for me. I was completely sold after that.”

Dr. Johnston received her BA and MD degrees from Brown University and completed her initial post graduate training at Rush Presbyterian St. Luke’s Medical Center in Chicago. She was trained in Neurology at Emory University Hospital, where she also completed a fellowship in Sleep Medicine. Dr.  Johnston is a partner in Atlanta Neurology, P.C. and served as Medical Director of the Sleep Disorders Center at Northside Hospital. She is board certified in Neurology and Sleep Medicine.

Creating AcuteCare Telemedicine in 2009 was an easy decision for Dr. Johnston and her partners. “We had an opportunity as a group to provide telemedicine services at a community hospital nearby,” Dr. Johnston remembers. “We realized that we could provide the same service to other similarly situated hospitals; alas, ACT was born.”

Knowing the value of teamwork, Dr. Johnston says she and her colleagues share a work environment that is trusting, reliable, and cohesive. “We four partners of ACT are very fortunate that as physicians we have worked together for the past 15 years, sharing patient cases, new ideas and future goals. On call duty, in certain ways, can be a very solitude and at times daunting part of being a physician. There is comfort in knowing that there is always a partner that is willing and able to provide backup if needed.”

Dr. Johnston notes their commitment is multi-faceted. “Not only are we the physicians taking care of patients through ACT, we are the owners of ACT,” Dr. Johnston says. “We have a vested interest, not only in providing superior quality care of patients, we have an interest in making our company thrive. There is an all-around positive energy into everything we do – caring for our patients, and caring for our company. It’s a great environment to be a part of.”

She sees the healthcare environment for telemedicine as an increasingly expanding area. “Unfortunately there is an exodus of neurologists away from hospital work and on call duty. There is a particular lack of neurologists in many rural hospitals,” Dr. Johnston says. “As the trend continues, the need for telemedicine is only going to grow, especially in the field of Neurology, where assessing an acute stroke patient can be swiftly and completely performed via remote presence.”

Dr. Johnston finds her inspiration in the fast-paced, challenging work that emanates from remote presence. “You are talking about trying to intervene either to save someone’s life or improve their quality of life, within a limited period of time. You have to be there ‘now’ and you have to be on,” she says. “You have to decide whether to take the jumpshot or pass the ball inside … and the clock is ticking.”

Edward Herring’s relationship with his daughter is a pillar of Dr. Johnston’s success today. Her late father would have been 90 years old this year. “My dad (with mom’s support of course!) made tremendous sacrifices for me and my brother; some sacrifices that took me until adulthood to appreciate,” Dr. Johnston says. “His own dreams were deferred in order that ours could be realized. I know that he would not have had it any other way.”

In what spare time she gets, Dr. Johnston enjoys traveling, photography and spending time laughing and simply enjoying life with her husband and their teenage son.

For Dr. Johnston, being able to care for patients on an emergency basis through AcuteCare Telemedicine is invaluable. “I know that when ACT is called to see a patient for an acute stroke, there is no other neurologist at that time at that facility who is available to provide care and that’s what makes the work ACT does so impactful. We are providing care to patients that otherwise might be delayed or simply unavailable,” she says. “To me, to be able to serve in this manner, is priceless.”



Has The VA Been Telehealth’s Most Effective Proving Ground?

Every new product, marketing campaign, movie or television series has something in common. Each go through a period of trial and error to work out the specific details of the product or production where problems, glitches, barriers or creative faux pas are tweaked and corrected before making a debut to the greater community. Each new plane has its test flights; each new television series has its pilot episode; and every new product has its test market before being premiered to the whole of the world.

The Veterans Administration (VA) has long been out in front of the medical industry when it comes to providing remote monitoring and the delivery of virtual healthcare to it patients. Charged with healing a significant patient population afflicted with chronic illness, most living long distances from VA care centers, the VA may be the ideal proving ground for a new and revolutionary healthcare delivery model.

A new study published by Adam Darkins, Chief Consultant for Telehealth Services, and published in EHR Intelligence, highlights some of the results of the virtual healthcare programs first piloted by the VA. The study reveals that 11 percent of veterans received some portion of their care remotely in 2013, a growth rate of some 22% over the previous year. The VA’s telehealth programs include video interactions between caregivers and patients, remote monitoring of chronic disease, and teleradiology. A new program, currently under evaluation, allows veterans to access treatment for mental disorders like post-traumatic stress disorder (PTSD) from remote locations through a secure video connection. The challenge of connecting to patients residing away from regional care centers mirrors that of the greater healthcare community, where patients living in rural areas often have limited access to specialized chronic care treatment and facilities.

The confined organizational environment of the VA has allowed it to effectively navigate around several barriers that continue to frustrate the wider expansion of telemedicine in the private sector: Payment for telemedical services, limited or inadequate technology info structure, and the individual state licensing requirements of telehealth practitioners.

It appears that the VA has been a respectable micro test environment to develop, design, engineer and ultimately introduce virtual healthcare services. Dr. Darkins says, “Telehealth in VA is the forerunner of a wider vision, one in which the relationship between patients and the health care system will dramatically change with the full realization of the ‘connected patient.’ The high levels of patient satisfaction with telehealth, and positive clinical outcomes, attest to this direction being the right one.”



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.”




Follow

Get every new post delivered to your Inbox.

Join 3,736 other followers