AcuteCare Telemedicine Blog


The Importance of Educating Legislators on Telehealth

Telemedicine legislation has been a frequent subject of much debate among healthcare professionals, Federal agencies, and State legislators. In recent news, the Governor of Delaware signed a new comprehensive telemedicine bill into law which requires healthcare companies to pay for telemedicine services at the same rate as in-person visits. Delaware joins 29 other states who have adopted similar requirements. U.S. Representative Mike Thompson is also actively working on the Medicare Telehealth Payment Parity Bill expanding the list of telehealth services available to Medicare patients.

In an effort to increase national attention on telehealth related issues, the American Telemedicine Association (ATA) is announcing The ATA Fall Forum, an event to educate members of Congress and push for important telemedicine policies. National Telehealth Lobby Day will be held on Capitol Hill in Washington DC. on September 16, 2015, and will be part of the event that includes training sessions on telehealth legislative priorities and expert tips on how telemedicine supporters can start discussions with Congressional leaders.

“Telemedicine has rapidly become the new standard of care,” comments Dr. Matthews Gwynn, Partner, AcuteCare Telemedicine. “In order to drive positive legislative change, we must educate legislators on the importance of access to telemedicine as well as the overall impact of telemedicine to patients and healthcare organizations.”

The Association leadership believes the best way to influence members of Congress is through face-to-face interactions with legislators. Federal and state legislation regarding physician licensing, care quality, scope of treatment and reimbursement of telemedicine is critical to expanding healthcare access and improving patient outcomes.

The ATA is the leading international resource and advocate for advanced remote medical technologies. Established in 1993, as a non-profit organization, the ATA membership works to fully integrate telemedicine into a transformed healthcare system to improve quality, equity and affordability of healthcare throughout the world. Their mission is to promote professional, ethical and equitable improvement in health care delivery through telecommunications and information technology. The ATA Fall Forum in an opportunity to further this mission.

“As a leading practice-based provider of telestroke care, we support initiatives that open a dialogue with legislators, practitioners, and healthcare leaders with the intent on drafting smart legislation that will have a positive impact on our healthcare system,” said Dr. Keith Sanders, Partner, AcuteCare Telemedicine.



AcuteCare Telemedicine (ACT) Exceeds Mid-Year Projections

AcuteCare Telemedicine (ACT), the leading practice-based provider of telemedicine services for healthcare organizations seeking around-the-clock stroke and other neurological care, exceeds mid-year projections, adding to its previous 5 years of successive growth.

“As we expand our geographic footprint, ACT has been able to attract enterprise level healthcare systems looking for acute stroke care to support a network of hospitals,” comments Dr. Matthews Gwynn, Partner, ACT.  “Our practice-base model enables us to seamlessly integrate with our client hospitals.”

In March, ACT announced a collaborative partnership with Bon Secours Neuroscience Institute (BSNI), the neuroscience division at the not-for-profit Catholic health system sponsored by Bon Secours Ministries. Patricia Lane, Bon Secours Richmond Administrative Director of Neurosciences says, “Working with the AcuteCare Telemedicine partners feels like an extension of the internal practice. They are truly in alignment with Bon Secours efforts to identify the right path to create continuity of care from the time the patient is admitted to our Emergency Room to the time they leave the hospital. AcuteCare is not just a provider, but invested team members who take pride in providing the best quality of neurological care to our patients.”

The American Academy of Neurology reports that stroke is the No. 4 cause of death in the United States and is also a leading cause of disability, creating a shortage of neurologists focused on stroke or acute stroke care.  “With the shortage of neurologists and increased demand for stroke care, especially in rural or underserved communities, ACT works with healthcare organizations to establish teleneurology programs that increase access to critical neurological care,” comments Dr. James Kiely, Partner, ACT. “We remain agile with each client so as to integrate with an existing teleneurology program or assist in establishing a new program, whether a rural hospital or a large healthcare system.”

“We are pleased with the growth of our business and even more excited about the number of hospitals and patients we positively impact,” comments Gwynn.



State Medical Boards Take Different Approaches to Regulating Telehealth

The recent headlines about the Texas State Medical Board’s (TMB’s) proposed new rules concerning the practice of telemedicine is managing to capitalize the national Telehealth debate. The TMB’s approach has ignited strong emotions and raised the intensity of conversations about the role of telemedicine throughout the medical community. The TMB, among other state medical boards, propose similar restrictions on the practice of telehealth, however the Indiana State Medical Board (ISMB) differs in its approach.

In April, the ISMB approved a trial program which allows Indiana residents to access virtual doctors and receive treatment without first having to establish an in-person relationship with the care provider. Before the pilot program, state medical officials allowed virtual appointments only between doctors and patients they had previously treated in person. The ISMB officials will evaluate how the new rules impact patient care and decide later this year whether to make the change permanent. Under the new rules, doctors can write antibiotic and other prescriptions, except for controlled pain medicines, for patients experiencing symptoms of flu, sinus infections, sprains, rashes and bronchitis. Doctors who practice telemedicine must be licensed in the state of Indiana.

The American Telemedicine Association (ATA) estimates that about 450,000 patients will see a doctor through the Internet this year for a primary care consultation. The number of patients who want to participate in virtual visits with their doctor is expected to increase as newer, easy-to-use mobile applications and devices become available. Convenience and cost savings are listed among its top reason for the increase in interest.

The American Medical Association (AMA) is looking at the ethical issues associated with virtual doctor visits due to the growing demand for the service. A recent survey found that 64 percent of participants would be willing to have a virtual doctor visit. The AMA states, “Rather than a blanket prohibition against diagnosing and prescribing, a more nuanced and sustainable approach would permit physicians utilizing telehealth/telemedicine technology to exercise discretion in conducting a diagnostic evaluation and prescribing therapy within certain safeguards.”

While similar in their concern for the quality and safety of patient care, the contrast between the TMB and the ISMB approach to implementing regulations governing virtual medical care could hardly be more different. While the TMB appears to be slamming the door on telemedicine as the new healthcare delivery model, the ISMB’s pilot program is a practical response which may just open doors to a better healthcare delivery model for their citizens.



Do State Medical Boards Need To Be More Forward-looking When Developing Telemedicine Rules?

Telemedicine has been around for several decades but 2015 is predicted as the year delivering healthcare through telemedicine reaches the tipping point. Patients are becoming more aware of the benefits of telehealth for routine medical services. Dr. James Kiely, Partner, AcuteCare Telemedicine LLC says, “State medical boards are struggling with finding a balance between patients’ demands for new models of care and patient safety as more consumers are embracing the convenience and lower costs of virtual visits and readily seeking routine and minor healthcare services through their smart phones, laptops and pads instead of face-to-face encounters with their doctors.”

The U.S. Congress and individual state legislatures are moving quickly to address payment, safety and quality of service concerns that accompany the new delivery model, which promises to increase access to medical specialist and lower the cost of routine visits to emergency rooms and physicians. The individual state medical boards, the governing bodies of healthcare delivery regulations and practice standards, are a bit more deliberate and inconsistent in setting forth new rules and regulations relative to the practice of telemedicine.

While one universal theme consistently centers on the premise that practicing telemedicine must use the same standard of care as healthcare services provided in person, collective commonality ends there. Although the majority of board efforts include guidelines, exceptions and standards of performance that address the important safety and quality concerns while permitting the practice of telehealth, some individual state board responses differ considerably.

The recent vote to accept proposed rule changes by the Texas Medical Board (TMB) might not be aligned with the majority of state medical boards. The new policy, which does not apply to mental health services, includes language that says physicians cannot prescribe a medication without first establishing a “defined physician-patient relationship.” That includes establishing a diagnosis through an examination performed during a face-to-face encounter.  This may be an effort to limit inappropriate dispensing of medications (e.g. broad spectrum antibiotics and narcotics), but appears to be sufficiently restrictive enough to effectively block the practice of most telehealth within the state.

In response to a legal challenge brought by telemedicine company Teladoc, federal Judge Robert Pitman, for U.S. District Court in Austin, Texas, issued a temporary restraining order and preliminary injunction to keep the TMB rules from going into effect. Teledoc, which operates in 48 states and performed nearly 300,000 virtual patient visits in 2014, challenged the legality of the TMB’s new rules. The American Telemedicine Association (ATA) expressed concern that “any policies addressing telemedicine not be overly prescriptive and inadvertently thwart the benefits of new technologies for improving care, expanding access and reducing costs.”

Given the more cooperative reactions of other state legislatures and medical boards, in regulating virtual healthcare across the country, the strict reaction of the TMB has proponents of telehealth questioning the reasoning behind the Boards restrictive posture. What is it about the delivery model that the Texas Board knows and fears that the rest of the medical community is missing? It is not that telemedicine is untested. In more than a decade of practice it has survived the scrutiny of industry experts and numerous regulatory bodies and has demonstrated its value to improving access and lowering costs while encouraging patients to take a more active personal role in their own medical care. Telemedicine is not a different kind of care, but rather a different method of delivering care.

The actions of the TMB certainly impact the implementation of telehealth programs nationwide, however they do not follow the actions of most state medical boards across the country. Nathaniel Lacktman, a partner at the law firm of Foley & Lardner and the leader of the firm’s telemedicine practice believes that the case could have implications for a number of other state boards as they develop rules surrounding telemedicine. Lacktman stated, “The court’s ruling may be a signal to state medical boards to be forward-looking and open-minded when developing rules, particularly when it comes to regulating new and innovative ways of providing healthcare to patients.”

Telemedicine is becoming a standard of care for specialty practices including neurology, cardiology, and psychiatry, among others. The hope is that each individual state medical board creates legislation supporting a healthcare solution that is designed to balance improved patient outcomes and increased access to quality care.



Elements Essential to Establishing a Successful Telemedicine Program

Several studies in recent years have indicated that the use of telecommunication technologies in the delivery of health care will rise dramatically as new technology is improved and its utilization perfected. Patients seeking healthcare through the use of fixed and mobile digital devices will reach 7 million by the year 2018. This predicted high demand for mHealth has existing providers scrambling to design an effective, high quality delivery model that meets the requirements of increasingly savvy consumers/patients. The projected increase in users of telemedicine services is also attracting a new wave of investor-supported entrepreneurs, eager to embark into the practice of virtual medical care. These new technologies make it possible for healthcare providers to monitor, measure, and interface with patients remotely while making it easier for patients to manage their own healthcare.

As healthcare companies and providers seek to implement telehealth solutions, it requires certain critical, essential elements necessary to the successful engagement of a connected-care-telemedicine practice:

Devices – The popularity and utilization of personal computing came about only after the deliberate evolution of devices that were simple and easy to use by inexperienced consumers. A telemedicine practice must use remote presence devices that are easy to use for the patient and promote a high level of confidence in the exchange of information with their physician.

Platform – Utilizing a platform that integrates telemedicine connections into a secure electronic medical record system will be essential to insuring quality and continuity of care. A software platform should be easily accessed by users and consistent with familiar digital formats and functions, but include cutting edge security measures in order to ensure the highest level of patient confidentiality.

Expert Practitioners – Telemedicine is not a new or different type of healthcare, but a different method of delivering the same quality of healthcare.  The physicians and care-givers must be equally skilled and proficient, not just in medicine, but also in technology.

Process Improvement – A successful telemedicine practice must establish key performance indicators that can be monitored and measured.  As the system is monitored and measured, telemedicine providers are able to make continual improvements to ensure the highest level of care.

The growth of telemedicine has become one of the most disruptive events in the delivery of healthcare in more than a century. Applying the technology to a well-established and confident system of care will come with certain challenges in its implementation. The impact will be derived, not by the technology or its devices, but rather from the healthcare professionals who incorporate these essential elements.



The Challenge of Connecting Telemedicine to Electronic Health Records

Much of the debate about telemedicine and the effect it is imposing on the established healthcare delivery model has been centered on the doctor/patient relationship and the adherence to maintaining a high standard of care, regardless of the method of interaction. While the importance of the patient and physician in the new electronic relationship is well understood, there is a third component essential to the successful integration of telemedicine. The ability to access patient’s medical information is critical to extending continuity of care for patients as well as improving transparency between telemedicine providers and healthcare organizations. Organizations are already integrating electronic health records (EHRs) systems but telemedicine adds another layer of integration.

To successfully access patient data, telehealth providers will need to achieve interoperability between various information technology systems and software applications and must be able to communicate, exchange data, and use the information that has been exchanged seamlessly across all types of digital communication devises. Tom Bizzaro, vice president of health policy for First Databank says, “We have to universally acknowledge the value of interoperability within healthcare IT systems. Indeed, sharing data across systems can help to improve care quality and efficiency in the country’s health system and lead to success of value-based reimbursement models. However, all players – providers, payers, patients and vendors alike – need to truly embrace the value EHR interoperability, putting it above any proprietary concerns.”

In speaking about the future of the connected healthcare system, Steve Cashman, CEO of HealthSpot, said “The future of the connected healthcare system lies in solutions that deliver care to patients where it’s most convenient for them through unique partnerships that extend the care of traditional health systems and local medical communities through different forms of mobile health and telemedicine. By embracing new technologies, we can treat a greater number of people with more efficient and relevant means of care. With the addition of cloud-based electronic health records and coordination of care between traditional and connected healthcare models, we can build an even better experience for patients and providers. Building connected healthcare systems will also allow us to engage with patients on a deeper level, incentivizing them to seek care and empowering them to participate in preventative measures.”

Congressional House leaders recently unveiled a draft of the 21st Century Cures Act, which aims to “accelerate the discovery, development, and delivery cycle to get promising new treatments and cures to patients more quickly.” The original draft did not include language pertaining to telemedicine, but a new draft includes language about the interoperability of electronic health records and requires electronic health records to be interoperable by Jan. 1, 2018. The College of Healthcare Information Management Executives (CHIME) President and CEO Russell Branzell and Board Chair Charles Christian want better patient identification to be included in the new legislation in order to better secure access to patient information. The duo called it the “the most significant challenge” to safe health information exchange. A subsequent statement by CHIME to FierceHealthIT read, “Increasing access to patient data alone will not translate into better patient care. We would encourage the committee to emphasize both the need to increase access and exchange health information, along with the value of being able to use the data to improve care.” The American Telemedicine Association (ATA) CEO Jonathan Linkous, expressed his hope that Congress will adopt “at least a few measures” to expand access to telemedicine.

The shift to EHRs in large healthcare organizations and in clinical practice certainly proved challenging.  As telemedicine becomes a standard of care, EHR integration becomes a key component to long-term success.

As AcuteCare expands into various healthcare organizations, Dr. James M. Kiely, Partner, AcuteCare Telemedicine (ACT) comments on the complexity of integration with EHR systems. “Currently, we are able to enter patient data via a secure but separate, web-based portal or by using some very good software that allows data integration. Both solutions require manual staff intervention which can often be slow and cumbersome; the antithesis of what telemedicine is supposed to represent. As with EHR integration, it might take considerable time and effort to create a platform that simplifies the integration.”



Rising Opportunities in Virtual Healthcare

While it may not be the .com bubble of the 90’s, telehealth and virtual healthcare initiatives are gaining popularity amidst investment communities across the globe. While some challenges still remain; individual state medical licensing reform, digital medical record keeping and some regional short-falls in technology infrastructure, a recent Wall Street Journal report on private equity firms investing in the health-care sector indicate increased investor interest in earlier stage opportunities. With the rising cost of healthcare, anticipated physician shortages and an increased demand for healthcare, virtual medical care is a way to solve the access and cost issues. Nirad Jain, a Bain partner and a co-author of Bain’s latest report on global health-care private equity, said “Health care is such an important part of the economy in the U.S. and globally, it impacts society in such a fundamental way that it is hard for a private equity firm of scale not to have some part of its portfolio in health care.” Private equity last year reached a three year high of $29.6 billion globally, nearly double the level recorded for 2013.

Telemedicine has been around for several decades but advances in digital infrastructure, software and the popularity of mobile devices by consumers is creating a tipping point for a budding virtual health industry. “Telemedicine is moving like lightning. We’re able to do so much more than before,” said Andrew Watson, Chief Medical Director of Telemedicine at University of Pittsburgh Medical Center.

Researchers at Mercom Capital Group estimated a 300% increase in funding flowing toward established and startup virtual-visit firms in 2014, and StartUp Health, a New York-based accelerator, and Rock Health, a San Francisco-based accelerator and seed fund, have independently reported that funding for new digital health ventures in the United States doubled last year. Rock Health estimates that $4.1 billion of new capital was invested in digital health in 2014, up from less than $1 billion in 2011.

“As practitioners in the telemedicine space, we’ve seen many technology platforms and telehealth delivery models enter the marketplace,” comments Dr. James Kiely, Partner, AcuteCare Telemedicine LLC.  “More consumers are embracing the convenience and lower costs of virtual visits and readily seeking routine and minor healthcare services through their smart phones, laptops and pads instead of face-to-face encounters with their doctors. As a result, healthcare organizations are moving quickly to implement telehealth initiatives across specialties such as neurology, cardiology, psychiatry, and other specialty programs.”

Whether or not virtual medicine and telehealth initiatives become the Facebook and Twitter of this decade remains to be seen. As investment dollars continue to rise, the future of telemedicine looks promising.




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