AcuteCare Telemedicine Blog


Study Reveals Application of Telemedicine Delivers Positive Outcomes

A recent study by The Agency for Healthcare Research and Quality (AHRQ) entitled Telehealth: Mapping the Evidence for Patient Outcomes from Systematic Reviews, indicates that that the application of telehealth delivers the most positive outcomes when used for remote patient monitoring, the treatment of several chronic health conditions and for psychotherapy as part of overall behavioral health. The leading chronic conditions, for telehealth success was cardiovascular and respiratory disease, according to the AHRQ study. The study’s authors also said that “research into practice-level implementation should be the next step, particularly since the vast majority of research conducted to date has been conducted within old and possibly soon-to-be-outdated care delivery models.”

The purpose of the study was to provide an overview of the large body of data about telehealth for use by healthcare decision makers. The approach used was to create an evidence map of systematic reviews published to date that assess the impact of telehealth on clinical outcomes. According to the report, the focus of future systematic reviews could include telehealth for consultation, uses in intensive care units and applications in maternal and child health. In addition, telemedicine for triage in urgent or primary care, management of serious pediatric conditions, patient outcomes for TeleDermatology, and the integration of behavioral and physical health were earmarked by AHRQ as ripe for analysis.

Healthcare remains a system where service is delivered primarily through in-person interactions, but many hospitals, physician groups and clinics as well as tech-savvy patient/consumers are turning to telemedicine to effectively and efficiently deliver and receive healthcare services regardless of their geographical location. The rise of utilization of telemedicine is one of the largest and most disruptive shifts in healthcare delivery over the last decade. With recent advances in telemedicine technology, an impending evolution in legislation governing the use of telehealth and falling regulatory barriers predicate that 2016 may be a turning point for the increased adoption of telemedical technology in the delivery of healthcare across a full spectrum of healthcare disciplines.



Paying for the Promises of Telemedicine

Telemedicine is living up to its hype on revolutionizing the healthcare delivery model. With many of the most formidable barriers to increased expansion being overcome, virtual technology is quickly becoming a preferred method for patients when connecting with their care provider. New advances in hardware and software coupled with faster digital info structure, is driving more and more healthcare professionals to electronic communications. Patients are warming-up to using new devices to relay their blood pressure, heart rate and other vital signs to their doctors so they can manage chronic conditions in the comfort of their home.

Healthcare providers, payers and governmen supported healthcare programs are recognizing the potential cost savings of telemedicine technologies. However, payment policies for telehealth services, while expanding quickly, continue to be inconsistent and are discouraging the progress towards realizing the full potential of virtual healthcare. Providers are eager to embrace telehealth. A survey of more than 1,500 family physicians conducted for Anthem and the American Academy of Family Physicians (AAFP) found that “almost 90% of respondents would use telehealth to help treat their patients—if they were compensated for that care.” Richard Bakalar, MD, managing director at KPMG and a member of the firm’s Global Healthcare Center of Excellence says, “Healthcare providers need to figure out how to become more efficient and the technology behind telemedicine allows caregivers to connect with patients remotely, efficiently and effectively.”

Currently payments for telehealth services are as far flung as the 50 states landscape. New rules for Medicaid managed care and MACRA are becoming telehealth-friendly, but Medicare and Medicaid reimbursements are spotty, with Medicaid payment varying greatly from state to state. Today, 48 states and the District of Columbia provide some form of Medicaid payment for telehealth services, according to the National Conference of State Legislatures. Commercial insurers seem to be embracing telehealth but consistency of payment policy remains elusive. In just over half of the states and the District of Columbia, private insurers are answering the call of parity laws that require them to pay for telehealth services. Payment parity is important for providers because it protects them against arbitrary cuts in reimbursement for telehealth services as compared to services provided in-person.

While expansion of virtual technology continues to progress at a steady pace, solutions to resolving remaining barriers like payment for services, multistate licensing, credentialing, and regulation are evolving at a deliberate pace.



What’s In Your Digital Health Tool Box?

The early implementers of telemedicine faced resistance, skepticism, and predicted peril from an industry that has followed a standard of care, governed by regulations. Those initial trailblazers have prevailed in their efforts to improve access to specialized care for patients living afar from major medical centers, enhancing patient’s healthcare experiences and reducing the unnecessary cost of specialized treatment and ongoing chronic care. Their persistent efforts to merge the latest digital technologies in communication with modern medical care has spawned new terms to languages all around the world; Telepsychiatry, Telestroke, Telemedicine, TeleICU and Telehealth, just to name a few.

Technology is having a wider impact on how healthcare providers connect with their patients and dispense treatment. This connected health revolution is making everyone active participant’s in their healthcare through an ever expanding network of devices and platforms. But as is often the case, development of new technology can outpace the ability of an industry and their consumers to accept and engage the new methods.

Consumers have demonstrated an impressive demand and utilization of digital healthcare tools like activity trackers, smart watches and their accompanying health apps, but nearly half of the users complain that their caregiver is failing to integrate the data into a personalized healthcare plan. A survey, conducted by HealthMine, called “The State and Impact of Digital Health Tools,” found that “a significant amount of digital health data is not reaching doctors or health plans and that there appears to be a disconnect between where consumers would like their self-collected health data to go and how easy it is to share it.”

Many physicians articulate an understandable concern about the accuracy of many of these devices and the process of collecting and transferring the data. In a recent article Vaughn Kauffman, a global practice leader in PwC’s Health Industries Advisory, indicated that physicians have some apprehension around taking in data from mHealth devices and wearables. “Some providers are further down the road than others around utilizing these kinds of data for engagement. There’s the potential to extend the doctor-patient relationship to beyond the direct doctor visit interaction. And obviously, this would involve individuals opting in, as opposed to kind of a Big Brother phenomenon.”

While wearables continue to be popular, many once avid users are discontinuing their engagement with the technology. Some indicate their waning interest is due to not understanding how the data collection will benefit them or enhance their digital health plan. Education and better understanding of the technology and how it can benefit both providers and patients in improving the delivery of healthcare will solidify the acceptance and use of the technology. The early pioneers of telemedicine have opened the trail to a much larger spectrum of services but wider engagement is still dependent on the ability of technology to deliver on its promises.



Is That The Sound Of Ice Breaking?

Until recently, the state of Arkansas was ranked last among all states in a recent report by the American Telemedicine Association on telemedicine practice standards. Like many other states, Arkansas’s treatment of healthcare via telecommunication technologies included restrictions forbidding caregivers the opportunity to treat a patient remotely without first establishing a face to face relationship. While other regulations purposefully and effectively deal with commonly acceptable policies that hold virtual healthcare treatment to the same standards of care as traditional in-person encounters; control the prescription of certain drugs via telemedicine; require the responsible handling of medical recording; and doctor/patient transparency, the restrictions on non-pre service face to face encounters and the insistence on individual state licensing of physicians is arguably the two regulations which proponents of telemedicine feel are hindering the wider adoption of telemedical services across the country.

Recently issued proposed amendments to its existing regulations have been approved by the State Legislature. Arkansas Code 17-80-117, will allow a doctor to establish a valid relationship with a patient without the need for an in-person exam, if the doctor “performs a face to face examination using real time audio and visual telemedicine technology that provides information at least equal to such information as would have been obtained by an in-person examination.” The rule also requires the doctor to establish a face to face follow-up visit when and if it is medically necessary.

The sound one hears from this action may just be the noise regulatory ice makes when it is breaking under the pressure of consumer demand and the application technological common sense. While the proposed changes do nothing to alleviate the cost and inconvenience of individual state physicians licensing requirements, the removal of the face-to-face, pre-telemedicine service requirement could open up the virtual care landscape in states where the face-to-face regulation still exists.

The Arkansas Board held a public hearing involving the proposed amendment to Regulation 2.8 and new Regulation 38 in June and encouraged telemedicine companies and healthcare providers looking to offer telemedicine services in Arkansas to review the proposed regulations and consider submitting comments.

Adoption of the proposed changes to Arkansas rules governing telehealth services may be seen as a water-shed action for healthcare professionals who believe consumers will benefit from both increased healthcare access and reduced cost when telemedicine is permitted to more freely expand across state lines.



Telemedicine is Closing the Gap Between Experts and Child Abuse Victims

Telemedicine’s entry into the healthcare process has been rather obvious over the past decade, particularly to those who have benefited from advanced stroke care, treatment for chronic diseases or convenient routine care for common illness. For those who live in areas away from advanced-care medical centers, telemedicine is closing the geographical gap to advanced, specialized treatment for stroke, diabetes and other coronary and neurologic disorders. As technology makes its way across the full spectrum of healthcare, providers are using the newest telemedicine technology to tackle one of their most difficult tasks: identifying a victim of child abuse or neglect.

Many cases of suspected child abuse arrive at hospital ERs, doctor’s offices or clinics where doctors and nurses can be less experienced in making a proper diagnosis. With the use of virtual technology the process of determining a proper diagnosis is enhanced, and the gap between child care experts and rural hospitals and advocacy centers closed. “We’ve saved lives, and we’ve saved families,” says Dr. Lori D. Frasier, division chief of child abuse pediatrics at Penn State Hershey Children’s Hospital.

The Department of Justice’s Office of Juvenile Justice and Delinquency Prevention and National Children’s Alliance provide financial support to more than 800 children’s advocacy centers across the country where treatment for victims of child abuse are benefiting from the use of telemedicine. It is also critical that a diagnosis of abuse be accurate. “The value is in the accuracy of the diagnosis,” says Patricia Goede, PhD, vice president of clinical informatics at XIFIN, “Over-interpreting something can be a huge cost to children and families.”

In Georgia, where much of the State’s populations reside in rural areas, the Children’s Healthcare of Atlanta Center for Safe and Healthy Children (CSHC) has used telemedicine since 2009. Jordan Greenbaum, M.D., Medical Director of Children’s CSHC says, “An evaluation utilizing telemedicine reduces parental anxiety and stress by providing prompt access to expert care and support. It also saves time and resources for authorities, who can lose a workday driving to and from Atlanta. And for rural medical providers, telemedicine relieves some of the burden of accurately identifying abuse and interpreting physical findings.”

In Florida a sharp increase in child abuse and a shortage of treatment specialist has exasperated an existing care differential between advanced care facilities and rural areas where child abuse rates are the highest. Providers in the state are working to expedite the development and initiation of telemedicine programs to address the growing problem. In the mid-west, at The Midwest Regional Children’s Advocacy Center at Children’s Minnesota, they’re utilizing the same platforms to share images and other tests and communicate with trained child abuse specialists.

Many formidable barriers to adoption and expansion of telemedicine remain, but as the utilization of the technology finds new and creative solutions across the range of medical services, closing the divide between specialized care and patients in need promises to remove many of the remaining, well-established opponents.



ACT Expands to Meet the Increasing Demands for Technology-Based Care

ResearchMoz.us recently published the results of new market research study titled ‘Telehealth and Telemedicine Market in HealthCare Industry 2015-2020’ which projects the global telemedicine market to grow 18.5 (CAGR) percent through 2019. It is clear that the healthcare industry is experiencing considerable growth in the use of digital technologies across a wide range of healthcare specialties such as telehealth, telestroke, wireless health monitoring, wearable health devices, and EMR.

One of the earliest adopters of telemedicine continues to advance in popularity with hospitals who seek around-the-clock stroke and other urgent Neurological care. As the demand for Neurologists increases, there is a growing shortage of experienced physicians available to provide continuous coverage at many facilities throughout the United States. AcuteCare Telemedicine (ACT), the leading practice-based provider of telemedicine services located in Atlanta, GA was founded in 2009 to help hospitals overcome medical staff obstacles, ER diversion and help improve patient outcomes for stroke and other Neurological conditions. Since the fourth quarter of 2015, ACT has added numerous client hospitals to their expanding network and is responding to the increased demand for these services by adding qualified neurologists to their team.

“We are dedicated to preserving and strengthening our reputation as leaders in the field of telestroke care and continue to be fully committed to serve the needs of both our patients and client hospitals in a manner that is personal and highly professional,” says James M. Kiely, ACT Partner.

ACT is experiencing an impressive performance by demonstrating its values of integrity, transparency, accountability, collaboration and expertise. Matthews W. Gwynn, CEO, and ACT Partner comments, “We’ve set the standard of care for teleneurology and acute stroke care. We also believe in the importance of remaining technology agnostic and agile, permitting our client hospitals and enterprise-level systems to select the specific technology that best fits the needs of their respective facilities.”

The growing firm is also focused on results, continuously measuring performance across all of the healthcare organizations it serves to identify how to improve the process so as to positively impact patient outcomes. “We are one of the only telestroke providers publishing data centered on the success of our program,” says Lisa H. Johnston, ACT Partner. “We’re proud of setting a standard for other providers to follow.” The study, titled “Improving Telestroke Treatment Times in an Expanding Network of Hospitals”, was published by the Journal of Stroke & Cerebrovascular Diseases and authored by Keith A. Sanders, MD, James M. Kiely, MD, PhD, Matthews W. Gwynn, MD, Lisa H. Johnston, MD and Rahul Patel, BS. The results indicate that a practice-based telemedicine system can produce meaningful improvement in markers of telestroke efficiency in the face of rapid growth of a telestroke network.

“ACT has developed a model of telestroke care that many of our competitors aren’t able to replicate,” comments Dr. Keith Sanders, Partner, ACT. “Our results prove that our business is able to create telestroke programs that are not only effective but sustainable. As clinicians, we measure our success on consistently providing the highest level of stroke care.”



The Importance of Measuring Performance

Telestroke, the use of communication technology to remotely treat victims of acute stroke, continues to grow and has entered the mainstream of care in an ever evolving and increasingly disruptive healthcare delivery model. Like all medical innovations, telestroke must demonstrate successful outcomes to achieve sustained growth and acceptance. Merely asserting that telemedicine is faster, employs the latest technology, or promotes a better use of limited re-sources is laudable but insufficient.

AcuteCare Telemedicine (ACT), a leading practice-based provider of Telemedicine services for hospitals seeking around-the-clock stroke and other urgent Neurological care, understands the importance of evaluating and documenting telestroke performance. In their recently published study “Improving Telestroke Treatment Times in an Expanding Network of Hospitals” the authors reveal that a practice-based telemedicine system can produce meaningful improvement in markers of telestroke efficiency.

“Success in our business isn’t just about adding new healthcare organizations to our client portfolio,’ says Dr. Matthews Gwynn, co-author and ACT partner. “As clinicians, we measure our success on consistently providing the highest level of stroke care and improving patient outcomes. This study is representative of our ongoing commitment to serve as a leader in telestroke care, establishing a standard of care and a model that supports the positive growth of telestroke programs across the country.”

As virtual health initiatives continue to move forward, new and valuable trends and telehealth technology solutions will continue to emerge. Traditional methods of delivering medical care will be challenged and disrupted at medical facilities, physicians’ offices and hospitals. Dr. Keith Sanders, ACT Partner and co-author comments, “It is critical to prove that our business is able to create telestroke programs that are not only effective but sustainable.”

For more information on how AcuteCare Telemedicine can assist you with acute stroke care, contact us!