AcuteCare Telemedicine Blog


Solving the Physician Shortage: Should it be Left to an Act of Congress?

Since 1997, the number of physicians entering the workforce each year has essentially been capped, while the demand for everything from hip replacements to treatments for diabetes to angioplasties has soared with our growing and aging population. Now, the Obama administrations newly proposed budget seeks to spend an additional $5.23 billion over the next decade to manufacture new physicians. While this sounds like a lot of money, given the magnitude of the doctor shortage issue, it won’t be nearly enough to solve the shortage problem on its own merits. The proposal is designed to swell the ranks of primary care doctors, those family physicians, general internists, and pediatricians that constitute the healthcare workforce that is predicted to experience the greatest shortage of all the medical disciplines.

But primary care is not the only medical care discipline that is facing future short falls.  According to a study by the American Academy of Neurology (AAN), by 2025 the demand for neurologists will far outnumber the supply, creating a 19 percent disparity in the number of doctors needed to adequately care for all patients. Those who suffer with neurodegenerative diseases like multiple sclerosis (MS), Parkinson’s, and Alzheimer’s will have to wait longer to see a specialist.

“The doctor shortage is worse than most people think,” says Steven Berk, M.D., dean of the School of Medicine at Texas Tech University. “The population is getting older, so there’s a greater need for physicians. At the same time, physicians are getting older, too, and they’re retiring earlier,” Berk says. And graying doctors, nearly half the nation’s 830,000 physicians are over age 50, are seeing fewer patients than they did four years ago.

The flow of doctors entering the market each year is determined by the number of U.S. residency positions, chiefly in teaching hospitals. Those positions are funded primarily by the program that oversees Medicare and Medicaid. In 1997, the federal government essentially froze spending on residency slots, limiting the number to around 100,000 over three-to-four years, and in turn freezing the number of newly licensed physicians available for hire each year to around 26,000. Over the past 17 years, a few hospitals have established new residency programs for primary care doctors, raising the number to around 27,000, or a less than 4% increase. Meanwhile, the U.S. population has risen by 50 million, or almost 20%. The American Association of Medical Colleges estimates that the U.S. will face a shortage of 46,000 primary care doctors by 2020, equivalent to one-quarter of everyone practicing in that category today.

The Affordable Care Act promises to magnify the problem but does attempt to address some of the issues to help stem its effect on the shortage by allocating an additional $1.5 billion in funding for the National Health Services Corps, which provides support to health care professionals in exchange for their service in areas with a more prevalent shortage. The law also puts more money toward training in hopes of increasing the primary care workforce and it offers more graduate positions for primary care doctors and more scholarships. It even offers a 10% bonus to primary care doctors who agree to see Medicare patients through 2015.

But many in the medical care industry do not see the solution reserved for government legislation alone. “Keep in mind the Affordable Care Act didn’t create this crisis,” said Dr. Reid Blackwelder, president of the American Academy of Family Physicians. “We’ve got an aging population that needs more care and a growing population.”

Many believe that new technologies will extend the reach of medicine in ways that will ameliorate the shortage problem. Health care professionals can serve more people by using telemedicine technologies to examine, treat and monitor patients remotely as well as providing patients increased access to advanced stroke care. These technologies are already keeping patients out of hospitals and doctors’ offices and providing improved recovery results. Creative new ways medicine is delivered, such as the use of “medical homes” and “accountable-care organizations” to better coordinate patient care, are also expected to improve efficiency and keep patients out of the hospital. Telemedicine enhances productivity and outreach while cutting costs, it improves diagnosis and care management in remote areas, and it reduces unnecessary care. The technology also strengthens partnerships between community based hospitals and advanced regional care centers.

“I understand there is a sense of worry, and change can be scary, but our present system is broken,” Dr. Blackwelder said. “We pay twice as much for our health in this country and have worse outcomes than other countries. Looking to government to fix a problem often harbors complexity, inefficiencies and long-term implementation of solutions. Dr. Blackwelder’s opinion reflects that of many other medical industry professionals, “We will have to start coming up with creative solutions to this problem, ones that won’t have to wait for an act from Congress.”



Removing Well Entrenched Impediments to Advancing Telemedicine Benefits

A recently published study in Telemedicine and e-Health found that despite numerous benefits to expanding telemedicine that there are three major barriers that remain to fully implementing the benefits of telehealth. Health care professionals agree that Telemedicine has and will continue to change care delivery and patient outcomes by expanding patient access, reducing service gaps, improving service quality, providing additional clinical support, delivering enhanced patient satisfaction and improved adherence to care standards.

Advances in powerful technology is transforming care facilitation, making real-time audiovisual communication more feasible and permitting physicians the ability to remotely consult with a patient via a robot and LCD screen.  Remote specialists and physicians can treat patients and save lives with the use of a broadband card, an internet connection from a cell phone tower and a laptop. This illustrates the amazing potential of telemedicine but the study found that serious human barriers to nationwide telemedicine still remain.

The study surveyed emergency and critical care remote presence telemedicine users from 53 healthcare institutions across North America and Ireland. One hundred-and-six surveys were completed. Sixty-eight percent of respondents were physicians, 17 percent nurses and nurse practitioners and 8 percent were administrators. The results indicated that three major human barriers for telemedicine in the areas of regulation and finance need eradication to fully implement the benefits of telemedicine.

     – Licensing for Physicians. A major benefit of telemedicine is the ability to consult remotely with physicians and patients across state boundaries, but today the current approach to medical licensing requires health providers to obtain multiple state licenses and adhere to diverse and sometimes conflicting state medical practice rules. The medical licensing process is not only complicated but also lengthy and expensive and it represents a major barrier to the expansion of telemedicine.

     – Credentialing. Credentialing can become very complicated especially for hospitals with hub and spoke models because physicians from each hospital have to have the credentials at every hospital.  The time it takes it to acquire all necessary documents and finish an application is time that could be used training medical staff to use telemedicine and bring the benefits of telemedicine to deserving patients. The current method for credentialing should be streamlined to facilitate easier credentialing at multiple facilities leading the way to wider telemedicine implementation and increased accessibility.

     – Reimbursement. A huge financial issue for telemedicine is the lack of reimbursement and capital expenditure for services. Similar to licensing issues, reimbursement models are different across the states with each having its own regulation for private payers with little or no consistency for telemedicine reimbursement.

Removing these impediments to the expansion of telemedicine remains a daunting task. Change never comes easy, particularly when it requires the cooperation of various bureaucratic agencies, multiple governing bodies and a wealth of well entrenched administrative procedures and regulations that were designed and implemented in a time when advanced communication technologies were little more than fantasy and science fiction. A continued focus on removing these barriers must intensify in order to bring the many proven benefits of telemedicine to patients throughout the country and the world.



Telehealth: Impacting the Practice of Primary Care

Hundreds of employers of all sizes are contracting directly or through their insurers with telehealth providers to cut medical costs and give workers 24-hour access to doctors and nurse practitioners. Recently, Beth Ferrin’s 9-year-old son came home with a swollen throat and fever. It was after dinner, so she flipped open her laptop and dialed into LiveHealth Online, a service offered by her insurer, WellPoint, (WLP) that connects patients with doctors via video calls. After a quick diagnosis of strep infection, a prescription for an antibiotic was called in to a pharmacy near Ferrin’s home in Bellbrook, Ohio. Her other options would have been to see a doctor in the morning or risk a long wait at an urgent care facility. Beth’s willingness to seek treatment for her son via telecommunication technology counters some telemedicine critic’s prediction that patient insistence on face to face encounters with their physicians would be a significant barrier to remote medical care’s rapid expansion. Now it would appear that barrier was overstated and, in part, has been overcome. 

But some very legitimate concerns continue to exist among physicians about the safety and effectiveness of remote medical care. When asked about the throat infection treatment of Ferrin’s son, Richard Rosenfeld, chairman of otolaryngology at SUNY Downstate Medical Center in Brooklyn, N.Y., said: “The only way to diagnose strep is with a test. Best practices say you can’t just throw an antibiotic at somebody.” He says there’s only so much a doctor can tell without an examination performed in-person and telemedicine visits could result in unnecessary medication. But Telemedicine care works well for treating common conditions such as colds, flu, pink eye, and sprains, providers say. 

The widespread use of camera-equipped devices has made remote medical connections easier, and high-definition video often provides enough detail for medical professionals to make diagnoses. The growth of Telemedicine has been spurred in part by the Affordable Care Act (ACA), which is funneling more patients into a system plagued by physician shortages. By 2020 the U.S. will have 91,500 fewer doctors than needed. The American Association of Medical Colleges estimates that the U.S. will face a shortage of 46,000 primary care doctors by 2020, equivalent to one-quarter of everyone practicing in that category today. Telehealth providers say they help make up for this shortfall by aiding doctors in delivering services more efficiently.

In response to concerns about the appropriateness of remote diagnosis and treatment, the American Telemedicine Association (ATA) is developing an accreditation program for telehealth providers and a bill introduced in Congress last year by Representatives Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio) would create federal telemedicine standards. Meanwhile, Telehealth companies are reporting double-digit revenue growth and attracting high-profile investors. MDLive CEO Randy Parker says. “Within the next few years, no consumer will even remember not being able to connect to their providers through telehealth.”



AcuteCare Telemedicine Leading Acute Care Telemedicine

The effort to provide high-quality healthcare solutions to every patient, regardless of geographic location, while reducing delivery costs is at the foundation of industry leaders efforts to revolutionize the traditional healthcare delivery model. Telemedicine is becoming the cornerstone of the solutions. Advances in telecommunication technologies is providing increased opportunities to decrease complications for patients in areas of high acuity like the critical care unit, as well as provide assistance in time-sensitive treatment decisions for emergencies such as stroke care.

InTouch Health® is the leader in acute care remote presence telemedicine. The company through its network of clinical care providers delivers innovative healthcare solutions that extend a doctor’s ability to manage patient care remotely, thereby removing critical time and distance barriers. The InTouch Telemedicine System allows physicians and other healthcare providers to conduct highly reliable, real-time, remote consultations.

AcuteCare Telemedicine (ACT), the largest practiced based provider of acute stroke and neurological care is now linked as a preferred provider with InTouch Health. Acute care telemedicine is an approach to urgent healthcare delivery in which specialists are focused on providing comprehensive, end-to-end remote presence clinical services, enabling a remote clinician to be interactively present in the patient environment and gather pertinent medical information through examination and data access to form a medical decision and care plan. With their remote expertise available at a moment’s notice, ACT is able to increase the likelihood that patients will obtain necessary stroke care within the critical “golden hour” following stroke recognition. The importance of using acute care telemedicine in the advancement of emergency healthcare is supported by the efforts of InTouch Health.

The ACT team of expert Neurologists is being recognized for setting new standards for excellence in Telestroke and urgent Teleneurology care. As clinical partners with hospital based and emergency physicians, they are positioned to successfully deliver remote, live and interactive Telestroke and other Teleneurology solutions that deliver the highest quality, affordable services and superior clinical outcomes for hospitals all around the world.



Why the VA is a Leader in Advancing Telemedicine

Initially used to reach those who live in rural areas, telemedicine is quickly expanding its reach into every area and genre of medical care delivery.

Interestingly, when the history of telemedicine is written, significant credit for hastening the advancement of telemedicine will go to a government health care agency that is not always credited with innovation and exemplary delivery of patient care and service.  The Department of Veterans Affairs (VA) is successfully deploying telemedicine on a large scale. In fiscal 2013, more than 600,000 veterans accessed VA care using telemedicine programs, for a total of more than 1.7 million episodes of care. The reach of VA’s telehealth services is growing at 22 percent a year. The agency is currently in the midst of a pilot program that allows veterans to enter vital information into an online tool that is accessible via mobile phones, tablets or desktop PCs to help their caregivers manage chronic conditions. The VA is launching another service that allows larger, better-resourced hospitals to connect with smaller facilities to provide remote support for intensive care.

“The VA did not get into telemedicine out of an inherent interest in technology”, said Dr. Adam Darkins, who leads national telehealth programs at the agency. Rather, VA officials wanted to help aging veterans with chronic disease live independently, for clinical and financial reasons. Although the VA has a network of 152 hospitals and more than 1,100 other caregiving facilities, it still faced the problem of having to cover a lot of territory in terms of reaching veterans. Additionally, officials found that 45 percent of those requiring treatment resided in counties classified as rural by the U.S. Census Bureau.

One big reason the Administration has been able to lead in the expansion of telehealth is attributed to its network of physicians who are able to treat veterans throughout the system without regard to state licensing rules, an advantage that private medical industry practitioners do not enjoy. The growing telemedicine industry is still working toward standardization and interoperability but the biggest impediments to the rapid expansion of telehealth remains state licensing and regulations that restrict treatment by out-of-state doctors.

Congress is beginning to take necessary legislative action to resolve many of the issues that are slowing telemedicine advancement in the private sector. The Telehealth Modernization Act, a companion bill backed by Reps. Bill Johnson (R-Ohio) and Doris Matsui (D-Calif.), would create a single, federal standard for telemedicine for use in national health care programs. And the Telehealth Enhancement Act from Reps. Gregg Harper (R-Miss.) and Peter Welch (D-Vt.) would expand reimbursement for telemedicine services under Medicare and Medicaid. It would also amend the Communications Act to support health care providers under the universal service requirement.

It’s not clear if any of those bills will pass, but the bipartisan focus on expanding telemedicine on that powerful committee indicates an interest in establishing some federal rules to make the patchwork of state laws more manageable for providers and insurance carriers. The VA has certainly provided an example of leadership as legislators clear the way for advancing the use of telecommunication technology in delivery medical care.