AcuteCare Telemedicine Blog


DR. MATTHEWS GWYNN RESPONDS TO WALL STREET JOURNAL ARTICLE

As telemedicine becomes a model for the delivery of healthcare, The Wall Street Journal recently published an article questioning if telemedicine could replace an ER visit. Read the full article included below as published in the Wall Street Journal on August 2, 2015 followed by Dr. Gwynn’s comments.

When a Doctor Is Always a Phone Call Away Many of the 136 million ER visits in 2011 could have been replaced with a $50 telemedicine consultation.

By

Richard Boxer

Aug. 2, 2015 5:30 p.m. ET 

A 39-year-old truck driver was hauling through the Midwest in the middle of the night in 2011 when he began to feel a bit of indigestion. Then a lot of indigestion. He pulled over, recalling that his company had recently signed on with Teladoc, for which I was then the chief medical officer. The service allowed him to get a doctor on the phone within 15 minutes. He called and described his symptoms: nausea, chest pain, a little numbness in his left arm. He was having a heart attack, and his GPS guided him to the nearest emergency room.

Getting that doctor on the phone saved his life, and potentially the lives of whoever his 10-ton rig might have plowed into had he keeled over behind the wheel. If efficient and affordable quality treatment is the goal, telemedicine should be the future of health care.

When it comes to health care, “efficient” is a word that frightens people, calling to mind a soulless bureaucracy with an eye on the company’s bottom line. But it is inefficiency that is overburdening the medical system. Consider a woman with a urinary-tract infection who has to leave work to obtain a prescription from a doctor for a drug she already knows she needs. Or a man with a fever and hacking cough who has good health insurance, but who goes to the emergency room because his doctor’s office is closed.

Americans are struggling to obtain affordable, convenient care, and 103 million people in the U.S. live in areas with a shortage of primary health-care providers, according to the Health Resources and Services Administration. Yet the country is dependent on expensive, brick-and-mortar facilities that require time-consuming travel. 

Primary-care doctors tend to cluster in urban areas. If you get sick in rural Wyoming, even during the workweek, your only choice might be the emergency room. In 2011, the Centers for Disease Control and Prevention reports, 136 million people were seen in an ER; many of those visits could have been replaced with a $50 telemedicine consultation. Researchers at the University of Rochester found that 28% of the visits at one pediatric emergency room involved ailments such as ear infections or sore throats that could be diagnosed over the phone.

These problems are exacerbated by the increase in the elderly population, coupled with tens of millions of patients newly insured by the Affordable Care Act. A study in the Annals of Family Medicine projects that the U.S. will need 52,000 more primary-care doctors by 2025. Those positions aren’t filled easily. It takes 12 years and hundreds of thousands of public dollars to educate one primary-care doctor.

But there is an untapped resource: the many doctors leaving their practices, fed up with the regulations and other hassles, but who love their patients, and the older physicians eyeing retirement because they no longer want to maintain an office. Why not let these doctors offer their expertise to patients by smartphone?

Doctors who contract with a telemedicine company can opt for a specific block of time when they are “on call” to patients, picking up the phone and answering questions in 10- to 15-minute intervals. The doctor is paid and the patient gets a prompt and inexpensive answer to a concern.

Home care of individuals with major chronic conditions would also substantially benefit from telemedicine. Millions of houses have cable and satellite connections that can be used to monitor patients wearing wireless devices, allowing health professionals to intercede at the first sign of trouble. This can reduce rates of hospitalization by half or more, some studies suggest.

While there is worry about the quality of these interactions, telemedicine companies assess their doctors routinely and maintain strong quality-assurance programs. Every doctor is taught in medical school that 80% of diagnoses are obtained through a medical history and symptoms, and not by what a doctor sees, touches or tests.

Telemedicine will never completely supplant face-to-face visits, and most doctors naturally would prefer to treat a patient in person. The American Medical Association, for instance, has encouraged restriction of telemedicine to patients who have an established relationship with a doctor, and some state medical boards try to enforce that view.

But the perfect cannot be the enemy of the good—and by continuing to practice medicine as usual, we are making it so. Millions of Americans live in areas that are short of primary-care doctors, and millions more go to the emergency room when they have a sore throat. Entrepreneurs have responded by creating methods of connecting patients to doctors remotely, which reduces costs and satisfies patients.

There is no scenario for sustaining or improving health care in America without telemedicine. State and federal governments, as well as the medical establishment, should embrace the technology. For one thing, they should change Medicare and Medicaid to allow reimbursement for telemedicine consultations, most of which are currently not covered. Ask that truck driver if he thinks talking to a doctor over the phone has value: He is still alive and trucking.

Dr. Boxer is the chief telehealth officer of Pager and chief medical officer of Well Via. 

Corrections & Amplifications

An earlier version of this article misstated the name of the journal that published a study of the need for 52,000 more primary-care doctors by 2025. It is the Annals of Family Medicine.

Dr. Matthews Gwynn, Partner, ACT, responds to the article saying, “One may argue plausibly whether a phone call, such as in Dr. Boxer’s example of the trucker, is adequate or not for general medical care, but there is no reasonable argument against audiovisual encounters combating emergency medical conditions such as stroke, provided remotely by experienced physicians to underserved urban, suburban and rural hospitals.”

Gwynn also comments, “In-person visits will likely remain the mainstay for local care for those fortunate enough to be around many physicians, but when minutes count in emergencies experts can step in and make the decisions that will determine a lifetime of health instead of a lifetime of disability. Telemedicine isn’t a fad but rather a disruptive innovation that flows naturally out of technological advances and has already contributed immensely to our society’s health. It’s a perfect fit for our shrinking resources.”

Telemedicine is a critical part of the new healthcare delivery model. As healthcare organizations begin adopting new practices, the conversation around proper use, application, and the effect on patient outcomes will continue.



ACT and Bon Secours Committed to Improving Patient Outcomes

ACT Bob Secour photo1

(Left to Right: Rahul Patel, ACT Data Manager, Dr. Keith Sanders, Partner at ACT, Patricia Lane, Administrative Director Neuroscience at Bon Secours Health System Richmond, Suzanne Doolan, Hospital Systems Manager at Genentech, and Dr. Lisa Johnston, Partner at ACT.)

Atlanta, GA: AcuteCare Telemedicine (ACT), the leading practice-based provider of Telemedicine services for hospitals seeking stroke and other urgent Neurological care, and the Bon Secours Neuroscience Institute (BSNI) established a collaborative partnership earlier this year to enhance BSNI’s “around the clock” neurological service. ACT and Bon Secours have developed a telemedicine model focused on improving the delivery of care and overall patient outcomes.

The fourth largest and only faith-based health system in Virginia, Bon Secours Virginia offers a full range of services including cardiac, women’s, children’s, orthopedics, oncology, neurosciences and surgery at eight award-winning hospitals. Bon Secours established its teleneurology program 5 years ago with a goal of having all of its area hospitals joint commission certified. Patricia Lane comments, “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 an invested team member who takes pride in providing the best quality of neurological care to our patients.”

BSNI patients are the focus and the most important benefactors of this collaboration. Patients are able to receive timely, remote, emergency consultations with AcuteCare Telemedicine neurology specialists. “Our commitment to providing the highest quality of care and ongoing collaboration with BSNI is sure to have a significant impact on the patients and the communities BSNI serves,” say Dr. Keith Sanders, Partner, ACT.

ACT hosted Patricia Lane, Administrative Director Neuroscience at Bon Secours Health System Richmond, and Suzanne Doolan, Hospital Systems Manager at Genentech to review stroke treatment processes and patient outcomes. “The advancements in teleneurology not only allow us to access more patients in need of our specialized care, but in providing acute stroke care we are able to improve patient outcomes overall,” commented Sanders. “The success of this collaboration hinges on a seamless execution and a continued effort to evaluate and implement improvements.”

AcuteCare Telemedicine continues to expand its geographic imprint in telestroke care, advancing the opportunity for healthcare institutions to gain access to highly-respected, expert neurologists and telemedicine technologies. For more information on how to implement teleneurology services at your healthcare organization, contact ACT. 

About AcuteCare Telemedicine

Founded in 2009, AcuteCare Telemedicine is a limited liability corporation advancing the opportunity for healthcare institutions to gain access to highly-respected, expert neurologists and telemedicine technologies. AcuteCare offers a range of services including first-rate neurological emergency response care with around-the-clock support and hospital accreditation education. AcuteCare primarily provides remote emergency neurology consultation which fills staffing needs and reduces the costs associated with 24/7 neurologist availability. As a result, healthcare institutions provide full service emergency neurology care and can earn Joint Commission Certification as a Primary Stroke Center.

About Bon Secours Virginia Health System

Bon Secours Virginia provides good help to thousands of Virginians through a network of hospitals, primary and specialty care practices, ambulatory care sites and continuing care facilities across the Commonwealth. The not-for-profit health system employs more than 12,500 people, including nearly 800 providers as part of the Bon Secours Medical Group.

The fourth largest and only faith-based health system in Virginia, Bon Secours Virginia offers a full range of services including cardiac, women’s, children’s, orthopaedics, oncology, neurosciences and surgery at eight award-winning hospitals.

– Bon Secours Richmond is St. Mary’s Hospital, Memorial Regional Medical Center, Richmond Community Hospital, Rappahannock General Hospital and St. Francis Medical Center.

– Bon Secours Hampton Roads is Maryview Medical Center, DePaul Medical Center and Mary Immaculate Hospital. 

About Bon Secours Virginia Health Care Foundation

The Bon Secours Virginia Health Care Foundation raises charitable funds to help Bon Secours Virginia Health System address the community’s growing health care needs with compassion and excellence. Through charitable support, we are dedicated to helping create healthy communities, advancing clinical innovation and providing an extraordinary experience of care. For more information on giving, visit www.bsvaf.org.



Telehealth Market Expected to Reach $17 Billion by 2020

Growth within the telemedicine marketplace continues to reach a fever pitch. Fueled by the shortage of physicians, increasing aged population, rising healthcare costs and expanding health insurance coverage for virtual healthcare, the emerging telemedicine market is set to soar in the coming decade. While some experts attribute telemedicine’s popularity to the to rise in smartphone use and consistent demand for quality virtual services, many healthcare systems are trying to reduce both the number of hospital visits and the length of stay in hospitals.

A new report entitled, “The Global Telemedicine Market Outlook 2020, studied the complete telemedicine industry which includes hardware, software and services. The telemedicine technologies market is anticipated to grow 8.4% and surpass $30 billion by 2020. “The report is a detailed study on the geographical distribution of telemedicine with the market sizes of North America, Europe and Asia-Pacific and provides an insight into different telemedicine applications.” North America is the largest market globally, accounting for more than 40 percent of the global market size.

Telemedicine, and the broader and increasingly more favorable term telehealth, includes medical services which use electronic information and telecommunications technologies to support long-distance clinical healthcare. The relationship between telemedicine and health IT is recognized as complementary by the reports researchers.

Another report from information and analytics firm HIS predicts video consultations will jump to nearly 27 million in the U.S. market, a doubling of virtual video consultations between primary health care providers and their patients, in the next five years. The IHS report projects a cumulative annual growth of nearly 25% a year to 5.4 million video consultations by 2020. Healthcare payers are recognizing telehealth as a way for patients to get high quality care from a physician and to avoid a more expensive trip to a hospital emergency room. “We’ve seen growth in reimbursement,” Roeen Roashan, medical technology analyst with IHS said in a recent interview. “Specialty consultations are projected to jump from 14.5 million to 21.5 million.”

As the industry reaches new heights, the pace of growth will continue to be moderated by tepid physician support, outdated reimbursement models, technology costs, and legal and governmental regulations regarding telehealth practices. The industry has made significant changes in delivery models for clinical and acute care in the last 5 years. Telemedicine and telehealth programs are certainly proving to be the future of healthcare.



Telemedicine, the Future Venue for Healthcare

While many believe that telemedicine first made its debut just a little more than a decade ago, the practice of telemedicine can be traced back to the early years of the space program. The National Aeronautics and Space Administration (NASA) pioneered the remote use of physiological measurements of astronauts and telemetered the data back to earth from the spacecraft. These early efforts from the 1960’s enhanced the development of satellite technology which led to the development of telemedicine. The decades since have brought significant advances to the technology, lower costs of equipment and an expansion of the potential uses in the medical industry.

Advancements in the fidelity, mobility and affordability of technology is changing the landscape for healthcare delivery. As the digital gadgetry becomes smaller, more portable and easier to use patient/consumers are advancing their expectations of telemedicine as payers look to reduce the costs of routine medical care and shorten the length of hospitalization. There is a vast array of new technology being applied to healthcare that promises to give patients more responsibility and control over their health and fitness. Wearable technology and wellness devices enable users to continuously monitor their vital signs and track their progress towards their fitness goals.

Future wearable devises will focus on accuracy and data integration as well as visualization capabilities; virtual models that promote the patients understanding and significance of the all the wellness data generated by the wearable devise.

The newest digital health trend, nanotechnology, may have a significant impact on healthcare. Nanotechnology’s precision and accuracy can aid in designing new drugs to specifically match a patients needs or monitor the progress of cancerous tumors in a patient’s body. While still in its infancy, nanotechnology is expected to be a significant digital health trend in coming years. Artificial intelligence is another digital health trend that will help physicians track a patient’s health and identify danger signs before an onset of a heart attack or stroke. As the costs of genome sequencing continues to decline, integration of personal genetics and research will advance the practice of genomics in the next few years.

“Access, cost, and convenience are driving it (technology) forward, plus advancement in technological capabilities”, says John Jesser, vice president of engagement strategy at Anthem Blue Cross, an affiliate of the Indianapolis-based WellPoint. “Historically, telehealth meant expensive video conferencing equipment in a clinic at one location and expensive video conferencing in a hospital somewhere else. (The technology) now allows doctors to log in and log out easily at their convenience and it allows patients to seek care when they want it, from their iPhone or Android. That’s changed everything,”

As virtual health initiatives move forward, new and valuable trends and telehealth technology solutions will continue to emerge and be adopted as the traditional methods of delivering medical care are challenged and disrupted at medical facilities, physicians’ offices and hospitals. The venue of choice for patients seeking medical in the future will more likely be smartphones, laptops, and tablets. The preferred provider will have to be knowlegable and comfortable with this rapidly changing healthcare delivery landscape.



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.




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