AcuteCare Telemedicine Blog


THE AMERICAN TELEMEDICINE ASSOCIATION PROVIDES A FORUM FOR THE ADVANCEMENT OF TECHNOLOGY AND HEALTHCARE PRACTICES

For more than 20 years, the American Telemedicine Association (ATA) Annual International Meeting & Trade Show has been the premier forum for healthcare professionals and entrepreneurs in the telemedicine, telehealth and mHealth space.  The event held at the Las Angeles Convention Center brought together 5000 attendees. With nearly a dozen keynote speakers and 13 educational tracks, it was a great opportunity for like-minded professionals to connect at the largest telemedicine trade show in the world.

With a focus on interactive learning, the ATA 2015 program offered a unique opportunity to learn and engage with leaders in healthcare technology. Attendees were able to take advantage of a myriad of educational and networking opportunities, interactive experiences, informal receptions and even digital networking sessions conducted through the ATA Meetings Mobile App.

The four day event promoted conversation centered on the challenges of advancing communication technologies and the implementation of potentially new provider service models. AcuteCare Telemedicine (ACT), the leading practice-based provider of Telemedicine services for hospitals seeking around-the-clock stroke and other urgent neurological care, took the opportunity to strengthen relationships with leaders in the industry. ACT’s expert team of neurologists is setting a new standard for excellence in telestroke and urgent teleneurology care.

The meeting was a great success, according to Matthews Gwynn, CEO of ACT. “We have enjoyed our long association with the ATA and continue to support their efforts to grow telemedicine throughout the United States and the world. As we expand our business, it’s critical to understand how telemedicine is evolving not just in stroke care but other areas such as cardiology, radiology, chronic care, and global specialty programs.”

Established in 1993 as a non-profit organization, the ATA is the leading international resource and advocate promoting the use of advanced remote medical technologies. Its diverse membership works to fully integrate telemedicine into transformed healthcare systems to improve quality, equity and affordability of healthcare throughout the world. AcuteCare Telemedicine is looking forward to next year’s meeting which is scheduled for May 14 through May 17, 2016 in Minneapolis MN.



Patching the Current System Will Not Advance the Great Promise of Telehealth

The deliberate march towards meeting the Federation of State Medical Boards’ (FSMB) goal of streamlining medical licensing of physicians continues. The FSMB promises that a new compact of seven states will trigger changes that will ultimately help reduce redundant licensing requirements by creating one place where physicians submit basic information such as their education and credentials. Last month Idaho and Utah were the latest states electing to join Montana and West Virginia as this compact attempts to speed up the process of licensing doctors across state boundaries. While some question why only seven states are required for implementation of this compact, just three more states are now needed to initiate the process that promises to remove a formidable barrier to telemedicine growth nationwide.

Despite being one of the most promising technologies to improve patient care and lower the rising costs of healthcare, telehealth is surviving in a regulatory environment that was established during an era devoid of modern telecommunication devices and technology. State physician licensing is currently controlled by 50 state medical licensing boards, each with their own requirements, policies and credentialing criteria. The current licensing process is a substantial impediment to the advancement of telehealth across state lines, sparking an intense debate over the need for a traditionally unpopular nationalized licensing system.

In an attempt to ward off yet another federal intrusion into states affairs, last year the FSMB proposed a voluntary national compact on joint licensing for the states. The goal is to secure the cooperation of enough states to quiet any calls to replace state-based physician licensing with a national program. The reason for the compact is that the FSMB previously approved a telemedicine policy that defines the location of the practice of medicine as the state where the patient is located, not the physician. The model legislation calls for at least seven states to participate in the compact in order to form a governing commission made up of representatives from the participating states.

From the outset industry leaders and telemedicine supporters saw the effort as a weak attempt to stem the growing tide to replace an outdated and inefficient system. The FSMB compact does little to address the cost associated with acquiring a license in each state and in fact increases the costs by adding fees associated with handling and processing the information.

Washington Board of Osteopathic Medicine and Surgery Executive Director Blake Maresh says, “For some, the interstate compact offers a tested Constitutional precept that could creatively forestall federal intervention that might otherwise supplant the longstanding authority of state medical boards, for others the possibility of other state boards licensing physicians who practice in their states, coupled with the establishment of new governmental organizations, leaves them uneasy at best.”

It is certain that the authors of state and federal constitutions could not have envisioned the advance of modern technology and the impact of those advances on preserving and improving the lives of their constituents. Delivering the benefits of increased access to the latest and best medical care, improved patient outcomes and lower costs must trump preserving outdated constitutional precepts. We must intensify our focus on implementing new processes designed to advance the great promises of telemedicine.



AcuteCare Telemedicine Advancing Stroke Care

A little more than a decade ago, telestroke and teleneurology were words that where not even part of our language but today are synonymous with the delivery of life-saving treatments for stroke. In a time when medical specialist are in short supply  among the nations smaller to mid-sized hospitals and increasing financial pressures make maintaining a neurology service difficult even at larger hospitals, many are turning to telestroke programs to assure their patients have access to the finest quality care available.  “Attracting and recruiting medical specialists is an ongoing challenge for smaller, regional hospitals who must balance the needs of their patients with the financial realities of healthcare in this demanding economy,” says Dr. Matthews Gwynn, Director and Founder of the Stroke Center of Northside Hospital in Atlanta and AcuteCare Telemedicine CEO. The combination of improving patient care, a growing shortage of neurology specialist and concerns over rising healthcare cost have converged to produce a significant increase in the utilization of communication technologies in the delivery of advanced stroke care

In a recent study, telestroke units helped increase the number of rural stroke patients treated and delivered treatment faster. In the 10-year evaluation of telestroke programs the study, published in the journal Stroke, found that the number of patients receiving the clot-busting drug tissue plasminogen activator (tPA) for ischemic stroke rose from 2.6 percent to 15.5 percent and the median time between a patient’s arrival at a regional hospital until tPA was administered fell from 80 minutes to 40 minutes. In addition, the median time between onset of stroke symptoms and receiving tPA fell from 150 minutes to 120 minutes. During the same decade, the number of patients transferred from regional hospitals to stroke centers declined from 11.5 percent to 7 percent.

Telemedicine continues to make significant progress in providing quality, specialized care for stroke and other neurological ailments and is improving access to this care for patients who live in remote outlying areas not served by major urban medical centers. According to the American Telemedicine Association, more than half of all U.S. hospitals now use some form of telemedicine.

According to a new study by Mayo Clinic researchers, telestroke programs are leading to lower cost. Stroke patients living in rural areas who receive care via a telestroke network experience, on average, nearly $1,500 in lower costs over their lifetime compared to stroke patients who do not receive telestroke care. The savings are primarily attributed to reduced resource utilization, including nursing home care and inpatient rehabilitation. The researchers evaluated a particular kind of telestroke care, with the healthcare provider acting as a hub that connects with a network of multiple hospitals, or spokes. They determined that when a telestroke system connects a hub with seven spokes it’s effective and cost-friendly for the patient. “This study shows that a hub-and-spoke telestroke network is not only cost-effective from the societal perspective, but it’s cost-saving,” said neurologist Bart Demaerschalk, MD, director of the Mayo Clinic Telestroke Program, and lead investigator of the study.

Thomas Hospital has been serving the communities of Baldwin County and Mobile Alabama for more than 50 years. A 150 bed hospital with a staff of more than 1300 dedicated medical professionals, Thomas Hospital has established a tradition for earning accolades for excellent service. Recently, in an effort to complement their existing neurological care department, the Hospital partnered with AcuteCare Telemedicine (ACT) and the Alabama Partnership for Telemedicine to provide virtual, 24 hour, seven days per week treatment for stroke and other neurological maladies. With its exemplary track record for providing outstanding care it is no surprise that it would seek to improve its neurological care services through the use of the latest communication technology. Dr. James M. Kiely, says “When you engage with AcuteCare Telemedicine you are engaging in more than a technical solution. You are gaining quality individuals to augment your medical staff.  Patients are able to engage with neurologists who are invested in their care.”

ACT has established itself as an innovator on the forefront of the industry, taking a unique approach to telemedicine by leveraging new technologies and techniques to enable personal neurology consultation when doctor and patient are in different locations. “The interaction between patients and families and us with the two-way, secure videoconferencing system that we have, it’s the same as being there,” says Dr. Keith A. Sanders, AcuteCare COO. “The Neurologic exam for stroke and emergency Neurology can be as safely and reliably done remotely as it is in person, I don’t think we miss anything by not being there.” With the help of ACT’s powerful and personalized services, patients throughout the ‘Stroke Belt’ states of the Southeast have drastically improved access to the care they deserve, and medical facilities increase efficiency while reducing the costs associated with maintaining a traditional emergency neurology staff. Whereas many hospitals with existing neurology departments simply do not have the resources to maintain around-the-clock clinician capacity, ACT has managed to successfully disrupt the trend and bring patient and physician together, regardless of geographical boundaries. Achieving this goal requires a certain level of investment in technology and trust in the people behind it. ACT is truly technology-agnostic.  This agility affords healthcare organizations with the ability to select the platform that meets budgetary and organizational parameters.

At Dodge County Hospital ACT partners with InTouch Health (InTouch), a leading developer and provider of remote presence devices and software, to bring remote telestroke care to its client hospitals. InTouch and ACT closely collaborate with their hospitals to easily integrate and improve the efficiency of the new remote service workflow processes as well as improve clinical performance and cost containment.  The client hospitals dedicated staff of medical professionals receive important, on-site training in the operation of the telecommunication robots and its software and form critical consultative relationships with ACT neurologist to ensure the highest quality patient care. “Having the ability to consult with a neurologist remotely for treatment of stroke and other neurological maladies is allowing these hospitals to meet the needs of the patients in the communities they serve,” says Dr. Gwynn. “We look forward to expanding our family of client partnerships throughout the region.

Hospitals all across America are finding the cost of telemedicine an affordable solution to ensuring improved accessibility of critical care and specialized treatment for their patients no matter where they live. Dr. Lisa Johnson, AcuteCare CFO, 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,” 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.”

If your hospital or hospital system is looking to establish a stroke center to offer the best in telestroke care, AcuteCare Telemedicine, as a practice-based provider, is the best solution. For more information, please contact ACT at info@acutecaretelemedicine.com.



Telehealth Legislation Continues to Evolve

Things are heating up in state and federal legislatures when it comes to advancing legislation that will help accelerate the spread of telehealth across America. The American Telemedicine Association (ATA) is working with congressional representatives to move forward on what is known as, “21st Century Cures”. The ATA is recommending that Congress take immediate action to improve coverage for telehealth services under Medicare payment innovations in a number of areas from fee-for-services to Accountable Care Organizations to bundled payment programs. The House and Energy Commerce Committee recently released a draft bill that will, in part, direct the Centers for Medicare and Medicaid Services (CMS) to implement a methodology for coverage of telehealth services.

Outside of Washington and all across the country, State legislatures are making telemedicine a priority issue for 2015. Ten states; Arizona, Arkansas, Connecticut, Montana, New Hampshire, New Mexico, Oklahoma, Virginia, West Virginia and Wyoming have introduced legislation that will impact how their state licensing boards enforce established clinical practice standards. In Arkansas, Connecticut, Indiana, New Jersey, Rhode Island, and Washington law makers are considering legislation that will require telehealth parity under private insurance.

In the state of Florida the battle to find acceptable legislative action to help increase access to health care in their rural communities is on-going. A bipartisan group of House and Senate leaders are confident they will reach agreement this year on how to boost the use of telemedicine in their state. “It’s abundantly important that we get it done and get it done right,” House Health Care Appropriations Chairman Matt Hudson, R-Naples, said during a news conference at the state Capitol in Tallahassee. As with several other states, law makers continue to struggle to pass legislation that satisfies legislators’ and healthcare industry concerns for the safety of patients and maintain the fiduciary responsibility of state government.

Lawmakers during the past few years have filed telemedicine bills that would allow for the use of modern telecommunication technology in the delivery of healthcare but the Florida House and Senate have not been able to reach an agreement. This year legislative leaders are expressing confidence that they can resolve their differences on regulatory issues. One of the points of disagreement in Florida and other states is the issue of individual state licensing and whether out-of-state physicians should be allowed to provide telemedical care to patients in their state. The current requirement and process of requiring a physician to be licensed in each state where treatment is rendered continues to be a significant stumbling block to the unabridged expansion of the practice of telehealth across state boundaries.

If the year 2015 is to become the predicted tipping point for expanding the benefits of technology driven medical care, state legislatures in Florida, and other states around the country, will need to do more than just debate and negotiate over the future of regulations that were relevant to times past.



Telemedicine is Providing Improved Access to Neurological Care

Before the introduction of telemedicine, small to medium sized rural hospitals often played the role of stabilize and transport centers, a brief stop-over for patients needing specialized treatment and care. Patients would receive treatment to stabilize their condition, were packed-up and then transported to urban healthcare centers where specialist were standing-by to administer much needed specialized treatment.

The process often results in delay for patients receiving important, often life-saving, treatment, inconvenience and increased costs. “Attracting and recruiting medical specialists is an ongoing challenge for smaller, regional hospitals who must balance the needs of their patients with the financial realities of healthcare in this demanding economy,” says Dr. Matthews Gwynn, Director and Founder of the Stroke Center of Northside Hospital and AcuteCare Telemedicine CEO.   The merging of telemedicine with neurology is changing the “stabilize, pack and ship” role of smaller hospitals and is bringing life-saving neurological and advanced stroke care to their patients within their own communities.

AcuteCare Telemedicine (ACT), the leading practice-based provider of Telemedicine services for hospitals seeking around-the-clock stroke and other urgent Neurological care is continuing to expand their portfolio of client hospitals with the recent addition of Dodge County Hospital. Located in Eastman, GA, the 94 bed healthcare facility is a Hospital Corporation of America (HCA) affiliate that is dedicated to meeting the challenges of a changing healthcare environment.

Dodge County Hospital is a prime example of how telemedicine is helping smaller regional medical facilities achieve their mission of delivering the highest quality healthcare services to their patients and their communities. “Having the ability to consult with a neurologist remotely for treatment of stroke and other neurological maladies is allowing these hospitals to meet the needs of the patients in the communities they serve,” says Dr. Gwynn.

ACT partners with InTouch Health (InTouch), a leading developer and provider of remote presence devices and software, to bring remote telemedical care to its client hospitals. InTouch and ACT closely collaborate with their hospitals to easily integrate and improve the efficiency of the new remote service workflow processes as well as improve clinical performance and cost containment.  The client hospitals dedicated staff of medical professionals receive important, on-site training in the operation of the telecommunication robots and its software and form critical consultative relationships with ACT neurologist to ensure the highest quality patient care.

Smaller hospitals all across America are finding the cost of telemedicine an affordable solution to ensuring improved accessibility of critical care and specialized treatment for their patients no matter where they live



The Building Momentum of Telehealth

Some proponents of telehealth are predicting that 2015 will be the year consumers will discover the convenience and cost benefits of accessing common health care through a virtual encounter. Telehealth has been reported to be on the precipice of rapid expansion for several years now, only to have the predictions fall short of expectations, mainly due to an established industry infrastructure that seemed to be well behind the present day technology curve. As service reimbursement, licensing and technical issues continue to fall-away many predict the time for a break-out in telehealth is upon the industry.

Entrepreneurs are taking the lead in providing opportunities for consumers to access common medical care services through virtual technology. More than 200 entities have entered the “doctor on call” market, connecting patients with a doctor for remedies for common every day ailments. In some parts of the country the service is becoming routine.This year more than 300,000 users will connect with a medical care provider over the internet, with that number predicted to grow to more than 7 million by 2018 as consumers discover the ease of use, convenience and lower costs. The initial concern that consumers would resist abandoning the traditional face-to-face office visit with their doctor has quickly dissipated as savvy; tech accepting consumers embraced the convenience of the new experience. The momentum continues to build, but is the other side of the doctor patient equation as prepared and eager to accept and embrace the new technological aspect of healthcare delivery?

For decades medical care has become increasingly industrialized and structured, primarily out of a need to control costs and manage available resources effectively and efficiently. The personal relationship between care giver and patient suffered as time was allocated to attending to increased numbers of patients. As primary care physicians integrate virtual encounters into their practice of care, the technology promises to provide new opportunities to once again place the relationship at the center of the care delivery. The addition of virtual encounters to the doctor/patient relationship promises many challenges to the largest and arguably the most important segment of the medical care industry, the general practitioner (GP), however, delegating the majority of follow-up or less critical visits to telecommunication may leave more time for developing the quality of the personal relationship through the face to face visit.

The clamor from the consumer is loud and clear but the growth rate of telehealth may be more dependent upon the medical professional’s willingness and preparedness to lead the way to the advancement of the new healthcare delivery model.

Your patients appear to be ready, are you?



A Telehealth Summit: Transforming the Delivery of Healthcare

The third-annual Alabama Rural Health & Telehealth Summit is scheduled for October 15 through October 17, 2014 at the Embassy Suites in Birmingham, AL. The Summit is sponsored by the Alabama Partnership for Telehealth (APT) and is the only statewide gathering of telehealth advocates in Alabama. This year’s theme is “Transforming the Delivery of Healthcare” and will feature a diverse and experienced group of presenters who will discuss the value of telehealth technology and how it is revolutionizing the delivery of healthcare across rural and urban America.

The Summit is open to primary and specialty care physicians, advanced practice nurse practitioners, physician assistants, registered nurses, medical care facilities administrators and anyone who is interested in learning more about healthcare reform through the application of modern telecommunication technology. More than a dozen topics and forums will be available for attendees over the three day summit, featuring the foremost experts in telemedical services and technology. The Summit is a great opportunity to learn more about state, regional and international Telemedicine initiatives.

On Thursday, October 16, James Kiely, PhD, MD, Chief Information Officer, AcuteCare Telemedicine, will moderate and present a session titled “The Reality of Telestroke: Real People, Real Results.” Dr. Kiely will be joined in the presentation by Cecilia Land, Division Director, Rehab Services, Southeast Alabama Medical Center, and Steven L. Skeen, BSN, CNO, Mizell Memorial Hospital.

Dr. James Kiely is board certified in Neurology and Clinical Neurophysiology and is the medical director of the neurophysiology labs at both Northside and St. Joseph’s Hospitals, and a partner at Atlanta Neurology in Atlanta. He was recently named one of America’s Top Doctors by US News and World Report, as well as being named a “Top Doctor” in Atlanta by Atlanta Magazine for the past five years. Dr. Kiely also serves as the Chief Information Officer for AcuteCare Telemedicine, LLC, an Atlanta-based corporation advancing the opportunity for healthcare institutions to gain access to expert neurologists and telemedicine technologies for 24/7/365 emergent neurological care.

Registration is available online for all those who wish to attend. The Embassy Suites Birmingham-Hoover is located at 2660 John Hawkins Parkway, Birmingham, AL 35244. For additional information on the Summit, contact Samantha Haas, Alabama Partnership for TeleHealth, Inc.



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.”



Clearing the Hurdles for Advancing Multistate Telemedicine

For the most part, the laws that govern the practice of medicine in the United States are state laws. One of the few things those laws agree on is that jurisdiction of those laws is based on the patient’s location, not the doctor’s. With the fast paced expansion of telemedicine technology and new mobile health opportunities bursting on the medical delivery scene, some well-established procedural hurdles are slowing the advancement of multistate practice of telemedicine. It is not that these procedures are necessarily bad it’s just that their creation and implementation are from a time when few could even imagine or foresee the advancements in the telecommunication technology of today.

The benefits of telemedicine to the delivery of healthcare, is becoming obvious to even the most resistant of detractors. “It’s relatively easy to do [telemedicine] if you’re going to stay within your particular state,” said Nathaniel Lacktman, a senior counsel at Foley and Lardner, “But if you really want to expand your reach, and be revolutionary or just make a whole lot of money, you’re going to need to go cross-border. Because of that you will be subject to the laws of that particular state. Across the country, where the patient is located, those are the laws that govern.” The six most common regulatory and procedural hurdles to expanding multistate telemedicine include:

Licensing

The American Telemedicine Association estimates that getting doctors licensed in additional states for telemedicine costs physicians $300 million per year. While some exceptions to state licensure laws have recently been put into place for telemedicine, most are not broad or consistent. For example, every state has a remote exception for post-surgical consultations. But some of those require the consultation to be free, some can only be hospital to hospital, and different states have different definitions of a consultation.

Scope of Practice

Every state board has the duty to enforce standard of care in their specific community and one of the most vexing standard of care provisions for telemedicine is the notion of doctor-patient relationships. Many states allow doctors and patients in an established relationship to meet virtually, but require the relationship to be established in an initial face-to-face meeting. To gain the most in quality and cost benefit from the practice of telemedicine, few face to face encounters between a patient and a doctor or specialist will occur prior to telemedicine treatment or consultation.

Credentialing

To practice hospital-to-hospital telemedicine, many hospital bylaws and state laws require physicians to be credentialed as if they were employees in the remote hospital, sometimes including maintaining their own health insurance, participating in staff education, and other requirements that don’t quite seem to apply.

The Centers for Medicare and Medicaid services have introduced a proxy rule for credentialing that could alleviate some of that pressure but in general practice, the myriad of credentialing requirements is overwhelming most attempts to efficiently overcome this barrier. Perhaps we can all agree on some common standardization of credentials to avoid unwanted implementation of federalized, “one size fits all” intervention.

Remote Prescribing

Remote prescribing is also covered under scope of practice, but with additional complications. Individual state pharmacy board’s standard of care, often have their own rules and the prescription of controlled substances can be regulated differently in different states. “There’s a whole set of rules on remote prescribing, what you’re allowed to do, what you’re not allowed to do,” Lacktman said. “Rule of thumb: prescribing is more restrictive than consults.”

Contracting

Contractual arrangements for physicians and other healthcare provider professionals differ greatly from one state to another. Attempting to practice across all states collectively is a minefield of differing contractual laws. For a business employing multiple doctors, the arrangement for paying doctors has to conform to all the states’ fee-splitting laws, practice of medicine laws, and anti-kickback statutes, which essentially prohibit doctors from buying and selling referrals.

As is often the case, the most admirable and beneficial accomplishments in any endeavor are rarely easy, but overhauling the well-entrenched, well-meaning bureaucratic regulations of the past is extremely daunting at the very least. It will require dedication and vision of all who seek to improve the delivery of healthcare to all Americans, no matter where they reside.



Stepping up and Getting Out in Front of the Revolution

Historically the healthcare industry has been notoriously slow to adopt innovation but one health insurance company is stepping out in front of their industry when it comes to demonstrating a willingness to pay for telemedicine services, recognizing the potential for cost savings and simplification of services.

At this year’s Connected Health Symposium in Boston, John Jesser, VP of Provider Engagement Services for WellPoint, explained that his company is partnering with American Well Systems, a telemedicine services vendor, to set up the program for its members. Before the program was set up, patients who needed to see a physician during off-hours had limited options: Visit the ER and spend about $600; see a physician in an urgent care center for about $150; or wait until the doctor is back in the office. WellPoint introduced a new choice for its members, which only costs about $49.

Patients are able to use a laptop computer, mobile device or tablet to connect with a primary care physician.  The encounter takes about 10 minutes to initiate, is HIPAA compliant and the service can be paid for with a credit card.  Medical history is available to the attending physician.  In addition to WellPoint, a number of other insurers including; Aetna, Highmark and Cigna are experimenting with similar programs for their member policy holders.  Following South Carolina’s State legislators recent introduction of SB 290 and HB 3779, requiring private insurers to cover telemedicine services, BlueCross BlueShield of South Carolina and Blue Choice HealthPlan of South Carolina announced that they would start paying for some telemedicine services.

But a recent tally from the American Telemedicine Association indicates that nationwide coverage will be a slow journey.  As of October 2013, there were only 20 states, and the District of Columbia, that required insurance companies to pay for some form of telemedicine services: Arizona, California, Colorado, Georgia, Hawaii, Kansas, Louisiana, Maine, Maryland, Michigan, Minnesota, Mississippi, Montana, New Hampshire, New Mexico, Oklahoma, Oregon, Texas, Vermont, and Virginia.

Insurers and state lawmakers aren’t the only ones with reservations about telemedicine. Ron Dixon, MD, the Director of the Virtual Practice at Massachusetts General Hospital (MGH), says, “I’ve found trying to get telehealth moving at MGH has been impeded by the way insurers pay for things. It’s been a big barrier to get it rolled into the way physicians actually practice.” He also believes that doctors resist offering telemedicine care because they simply have too much to do. “If you are going to get doctors involved, there has to be a win for them, and the win is usually time. It’s not always about the money.”

Massachusetts General Hospital has built a tool that allows existing patients to get their follow-up care online. The hospital pays providers for the service, and while the fees they receive are less than what they get for in-person visits, it also takes them less time to see a patient online, so it tends to balance out.

If the full benefits of telemedicine services are to realized, more insurers and practitioners will need to step up and overcome their reluctance to technologies that promise to revolutionize the traditional healthcare delivery model.