AcuteCare Telemedicine Blog

Circumventing Persistent Barriers to Telemedicine Expansion

For professional care givers and others who believe in the costs reduction benefits and increased care availability derived from telemedical technology a few persistent barriers are proving to be frustrating and annoying. While the emerging innovations are poised to break out from the evaluation phase to full blown market utilization, proponents are using everything at their disposal to nudge a few remaining barriers that stand in the way of accelerated implementation.

The physician-doctor relationship requires an in-person medical visit.

It is a well-documented view that a face-to-face visit with a physician is essential to establishing a relationship with a patient and that the quality of the treatment will be somehow diminished without the one-on-one physical relationship.  Some of this push back is rooted in state regulations and laws or is the result of well-established educational standards and professional guidelines and norms.  Many doctors believe that in order to gather the necessary information about a patient’s medical condition they must meet in-person.  Although that may be true in some cases, doctors usually conduct a very general exam through conversation, not palpation.  As and practitioners become more confident and practiced in the new technology, relative improvements in confidence and personal skill-sets should chip away at the effectiveness of this factor as a barrier to meaningful progress.

The Robert J. Waters Center for Telemedicine and eHealth Law (CTeL) recently published its proposed “Electronic Examination for Telemedicine Prescribing. These templates “would ensure that patient safety would be upheld and would provide clarity for telemedicine providers who wrestle with prescribing in states where the use of an electronic ‘face-to-face’ examination is not specifically identified.”  The proposed statutory language would waive the face-to-face exam when “it would not normally be part of a typical face-to-face encounter with the patient for the specific services being provided.” 

Physicians are required to hold a valid medical license for each state in which they see patients.

Few physicians will advocate for a centralized federal bureaucracy to oversee medical licensing or propose that individual medical boards’ authority be diminished.  The    individual state licensing requirement is a holdover from when state medical boards tested licensed applicants.  Now the National Board of Medical Examiners administers, the United State Medical Licensing Examination (USMLE), and state medical boards just ask for verification indicating that an applicant has passed all three elements of the test.  Today each state has continued to have different requirements for practicing telemedicine, a formidable barrier to expansion of technology that is sure to remain for some time to come.  However, The Federation of State Medical Boards (FSMB) is reaching out to representatives of state medical boards to explore the idea of a streamlined licensing process so as to better accommodate the use of telemedicine. 

The point of medical care depends on the location of the patient.

A similar restriction to individual licensing, this requirement has an easier solution and one that is currently being addressed by legislation.  A comprehensive telemedicine bill, introduced in Congress by California Congressman Mike Thompson, would change the point of care to where the doctor is.  The significance of this simple proposal is that a physician could see patients anywhere in or from the state where he holds a valid license.  Thompson’s measure does not create a national telemedicine license because the last thing the medical care industry needs is another level of bureaucracy between the doctor and his patient.

Outdated limitations on Medicare reimbursement for telemedicine services.

In 2001, limitations in Medicare payments were implemented and were aimed at discouraging the adoption of telemedicine within urban areas. It was then widely believed that unrestrained doctors would overuse telemedicine and run up giant reimbursements.  Government accountants predicted that telemedicine visits would cost $30 million each year for the first five years, however, that prediction fell well-short of reality. In the 11 years since the reimbursements were approved, the total amount approved for telemedicine was just over $20 million.  It is time that restrictions better reflect historic results.

Delivering adequate healthcare in the 21st century demands significant change in the current healthcare delivery model and will require even more significant change in attitudes about well-established and equally well-intentioned processes, social norms and regulations born and reared in past decades and generations.

AcuteCare Telemedicine and the American Telemedicine Association Team Up in Austin Texas

American Telemedicine Association (ATA) held their 18th Annual International Meeting and Trade Show On May 5-7 in Austin, Texas.  More than 6000 healthcare professionals and entrepreneurs in the telemedicine, telehealth and mhealth industries attended the premier forum on telemedical technology and health care services.

This year’s event offered more than 500 educational presentations and 300 exhibitors including AcuteCare Telemedicine (ACT), a leading practice-based Neurology provider of Telemedicine services. A day long video, a technical demonstration with GPT and InTouch and information on ACT telemedicine services was presented at the AcuteCare booth. ACT representatives sought out potential business opportunities throughout the conference with other vendors and service providers from markets in Mississippi, Arkansas, Florida and Latin America

Dr. Keith A. Sanders, from ACT, attended the “Telemedicine Venture Fair”, which featured industry experts from the Venture Capital community who shared their expertise and advice on strategic partnerships and venture financing with attending Telemedicine start-ups.  In addition, fellow ACT members attended multiple educational and business development presentations on neurology telemedicine. Speakers from UPMC in Pittsburgh, PA focused the discussions on topics concerning return on investment and business sustainability models.

During the three day event, The American Telemedicine Association named the winners of its prestigious annual awards and announced the election of two new members to the ATA College of Fellows. The winners of the 2013 ATA Awards represent the true innovators and best-of-the-best in our field,” said Stewart Ferguson, PhD, President of the American Telemedicine Association. “These individuals and organizations have proven that telemedicine is an invaluable tool in saving lives and improving healthcare, both here in the United States and around the world.  We are honored to recognize their great accomplishments.”

The American Telemedicine Association is the leading resource which advocates promoting the use of advanced remote medical technologies.  The diverse membership works to fully integrate telemedicine into healthcare systems in order to improve quality, equity and the affordability of healthcare to millions of people around the world.

Is There a Doctor in the House?

For those who can still remember the day when your family physician came to the house in response to a telephone call requesting medical service, the current debate over the acceptance of telemedical services in place of face-to-face visits with a doctor will bring back memories of a similar debate exorcised over the abandonment of house calls with in-office visits. Back then the vocal decry from opponents to the change suggested that patients would reject the idea and inconvenience of traveling to the doctor’s office to receive medical care and that somehow the process would have a negative effect on the quality of health care.

Few predict that the face-to-face, hands on, talk to me now visits with a physician is likely to go the way of the personal home visits anytime soon.  However, organizations resistant to changes with the current medical services delivery model and are unwilling to consider utilizing telecommunication technology will not be able to meet the growing demands of the patients and communities they serve.

A recent study by Cisco reveals that 74 percent of consumers are open to virtual doctor visits.  The results of the Global Customer Experience Report focused on health care, demonstrated a shift in consumer attitudes toward personal data, telemedicine and electronic access to medical information. The global report conducted in early 2013, includes responses from 1,547 consumers and HCDMs across ten countries.

The results indicated that 80 percent of American’s were comfortable with submitting personal medical and diagnostic information to the cloud to help ensure that all relevant personal medical information is readily available to receive treatment.  Perhaps the most interesting result was that the findings challenged the assumption that face-to-face interaction is always the preferred health care experience by consumers. While consumers still depend heavily on in person medical treatments, given a choice between virtual access to care and human contact three quarters of patients and citizens would choose access to care and are comfortable with the use of technology for the clinician interaction.

The benefits of face-to-face visits to quality of care are valid and current telemedical service visits will not likely replace all physician/patient personal interactions anytime soon, nor should they.  But recurring studies are beginning to reveal that patient’s reluctance and suspicions of telemedicine is no longer a valid excuse for delaying the broader expansion of telemedical services.

Perhaps we shouldn’t be all that surprised that patient objections to a reduction in face-to-face doctor office visits are fading.  Consulting with your family health care practitioner, via telecommunication technology, in the comfort and convenience of your own home has a familiar ring.  House calls revisited? What goes around comes around?



ACT Collaborates with Southeastern Medical Center on Telestroke Network

AcuteCare Telemedicine (ACT), the Southeast region’s largest practice based telemedicine provider, participated at Southeastern Alabama Medical Center’s (SAMC) press conference, announcing SAMC’s new stroke care network.

SAMC’s service area covers over 60 miles in each direction.  With technology in place, SAMC looked at possible resources to staff the new 24X7 model.  Neurologists on staff at SAMC are responsible for patients after admittance to the hospital, and often following acute symptoms or neurological events.  To be able to provide 24X7 coverage would be impossible. SAMC selected AcuteCare Telemedicine as its clinical service provider.

With this hub-spoke stroke care model, SAMC will be able to add hospitals to its network, expanding coverage across its communities.  Patients have already started to receive care, including tPA.  The initial results show improved patient outcomes.   The goal of the stroke care network is to educate communities on the importance of wellness, to identify signs before a stroke and generate awareness for the new services offerings SAMC can provide.

“Telemedicine is such a new technology for our population. We had concerns about patient adoption and comfort with being diagnosed remotely,” comments Ceclia Land, Division Director, Rehabilitation Services, SAMC.  “However, ACT integrated seamlessly into our processes, working alongside our team, to insure only the highest level of care to our patients. All of the doctors at ACT have an incredible bedside manner and are engaging.  They have become an integral part of our team.”

ACT will be on hand to diagnose and treat acute care patients. ACT offers cost-effective solutions that deliver complete on-call coverage, improve patient outcomes that adhere to HIPAA / HITECH requirements and establish a sustainable financial model for patient care.  The ACT Team of Neurological specialists are in the business of creating relationships that will serve as the foundation for improving healthcare for communities across the Southeast and Nationwide.

“SAMC has really established the new standard of care, expanding access to specialty care in underserved communities,” comments Dr. Gwynn, CEO, Partner, ACT.  “We look forward to our continued involvement with SAMC and its patients.  We have the potential to improve the statistics for residents across these communities in the hopes of saving lives lost due to stroke.  If diagnosed in time, we are able to administer tissue plasminogen activator (tPA) decreasing patient deficits after the stroke.”

The Dollars and Sense of Telemedicine

With the anticipated “break out” of telemedicine services looming on the horizon, an important and significant obstacle still remains to be cleared away if wide-spread expansion and acceptance of medical treatment and services is to be realized.  As with the growth of any new industry it raises the question of who is going to provide the investment capital and who is ultimately going to pay for the services necessary to sustain the budding industry?

Even with the obvious benefits that telemedical services promises to bring to the traditional health care delivery model, change to the well-established and traditional minded payers of medical services continues to be a major detriment to the crack of the starter’s pistol that will unleash the race to expansion.  Currently there are five primary sources of funding for the $2.8 trillion healthcare markets in the United States, according to Jon Linkous, American Telemedicine Association (ATA) CEO.

Hospital and Healthcare Systems now permits providers the flexibility to pay for telemedicine services wherever warranted, over 100 million Americans are now covered and the number is growing rapidly.  This source remains the most fit of providers readily eager to set the pace.

Private and public employee insurers in the U.S. are expanding coverage of telemedicine but only 16 states currently mandate private insurance coverage.  This important source of funding continues to lag well behind the pace and is not likely to contribute seriously to a break-out soon.

Federal Medicare payments are currently approved for imaging and live consultations to patients in rural areas and Congress is expected to take up expansion of the payments in the coming year, but this is Congress an agency not known for leading or setting any records for implementing change.

State Medicaid coverage is available in 44 states at some level of reimbursement and three more states are considering full support in 2013.  In April, legislators in Arizona passed a law prohibiting insurers from denying payment for medical services solely because they are provided through telemedicine. The law is limited to providing payments in 13 specific rural areas and only for telemedicine treatment for seven specific conditions. The laws implementation was delayed until the end of 2014 to satisfy insurance industry concerns.  Such tentative, piecemeal advances’ provides little hope for a surge in Telemedical services being paid for by Medicaid provider’s in Arizona.  Apparently, as with justice, the wheels of bureaucratic change move slowly.

Direct federal healthcare agencies, such as the U.S. Veterans Administration, Department of Defense, Indian Health Service, federal and state and local corrections departments are active providers of remote health care.  This is rapidly expanding and increasingly relies on partnerships with non-governmental health providers.

Investment capital remains a concern for providers looking to aggressively enter the telemedical marketplace. While the mystery of how the new technology will generate returns on investment begin to fade in investors and venture capitalist minds, infrastructure funding sources are limited and somewhat timid in this hesitant economic environment.

The benefits of telemedicine to improve the access and quality of patient care is obvious, and makes perfect sense to providers, practitioners and patients alike, but the dollars portion of the “dollars and sense equation” is proving to be a more persistent challenge to expansion and sustainable growth of this new industry.

The VA Deploys Telemedicine and Telehealth Programs

The Department of Veterans Affairs  (VA) has released a comprehensive 400-page report that outlines its successes last year in the effort to improve veterans’ access to quality healthcare, including the implementation of an extensive telemedicine program. The report concludes that the use of telemedicine and telehealth has significantly improved veterans’ access to quality healthcare, and quality of life, by reducing the amount of time and travel needed to receive care.

The news is particularly encouraging given the performance level of the federal agency that is charged with providing ongoing medical care for millions of our nation’s military veterans.  Veteran Hospitals (VA Hospitals) have historically been located near large metropolitan areas, requiring patients to travel long distances for even the most basic of medical services.  The agency is making significant changes to its system, consolidating specific treatment into regional locations, causing some patients to be concerned about traveling even longer distances to receive their VA Medical Benefits.

Most recently the Agency has come under attack for its inability to process a long backlog of claims resulting in some veterans who have been waiting for treatment to coin the phrase, “Delay, Deny, and Wait Till I Die”.  Embracing the new telemedicine and telehealth technology programs may be the most promising decision the agency has made in the recent past to help turn the long history of inefficiency and questioned quality of care around.

The Department of Veterans Affairs (VA) 2012 Performance and Accountability Report, submitted by Secretary of Veterans Affairs Eric Shinseki in November, discusses the Department’s achievements in improving healthcare and benefits service delivery to veterans.  The report states that in 2012, the VA maintained the largest integrated healthcare system in America and implemented “new innovative practices to improve Veterans’ access to health care, such as telemedicine and mobile clinics, to provide care to more than 6 million unique patients.” Throughout 2012, nearly 500,000 veteran patients received 1.4 million telehealth-based consultations, which were delivered from 150 VA Medical Centers and 750 Outpatient Clinics.

Supporters of the VA’s utilization of the latest technologies to expand access to quality, primary and specialty care believe that it will transform healthcare delivery at VA Medical Centers while providing veterans solutions that enable greater access to their benefits, at a lower cost, all while improving the quality and outcomes of the medical care.

Telemedicine and telehealth technology is demonstrating its benefits of improved care, increased access and lower costs in the private sector.  Let’s hope that its application and practice at the VA demonstrates an equal measure of success.  Our military members risked their lives and suffered countless injuries in service to our country.  They deserve efficient, accessible, quality medical care for their commitment and sacrifice for protecting our freedoms and our country’s security.