AcuteCare Telemedicine Blog


EMS Role is Critical to Stroke Treatment and Recovery

Each year, almost 800,000 Americans suffer a stroke, on average one American suffers a stroke every 40 seconds and one victim dies every 3 to 4 minutes making stroke the third leading cause of death in this country, after heart disease and cancer.

Innovations in the treatment of stroke have provided many new options for physicians and emergency room personnel over the past half-decade, but getting the stroke victim to the most effective treatment center still remains a critical element in a victims long term survival. EMS is a part of the success of any telemedicine program. Being able to quickly assess a patient to identify acute stroke symptoms is one thing – getting the patient to the closest most equipped hospital is another. Hospital associations and telestroke providers need to include EMS in the conversation as it will dramatically impact the lives in acute stroke events.  EMS teams must have a goal of getting potential stroke victims stabilized, evaluated, and to a primary stroke center in less than an hour.

To plan for an effective response, directors of EMS units should have a preplanned stroke protocol written for their teams, divide the EMS unit’s region into districts according to the nearest emergency department capable of treating acute strokes and maintain regular training sessions for EMS personnel.

The Utah Department of Health and The Bureau of Emergency Medical Services are leading the way in establishing effective procedures and communications to EMS personnel when it comes to transporting patients for the treatment of stroke. The Bureau has identified eight regional hospitals throughout the state as “Primary Stroke Centers”, hospitals that have undergone certification by the Joint Commission or DNV as specialized centers providing the highest level of comprehensive stoke care. This includes advanced time-critical emergency stroke care, including specialized radiology, neurology, and neurosurgery expertise, as well as complete inpatient treatment and outpatient rehabilitative programs for stroke patients.  In addition, 17 localized hospitals have been designated as “Stroke Receiving Facilities”, centers that have procedures, equipment, and protocols in place to provide time-critical emergency stroke care, in consultation with one of the Primary Stroke Centers.

For stroke victims, there is less than 4.5-hours after the onset of symptoms in which thrombolytic therapy offers an enhanced opportunity for a patient’s recovery.  Educating and training EMS and First Responders to identify, properly evaluate and transport victims to a Primary Stroke Center, or a Stroke Receiving Facility, is critical to the successful outcome of treatment for stroke victims.



Long Distance Learning

Along with other massive changes brought on by the increasing power and reach of the internet, the past decade has seen a drastic increase in the number of undergraduate and graduate degrees attained online. Today, more than 12,000 different “digital degrees” can be obtained from accredited U.S. universities, a figure that has grown by double digits annually for the last five years.

While the growth of the internet has enabled a plethora of such ‘distance learning’ opportunities for collegiate education, new technologies and practices in telemedicine are simultaneously reinventing the approach to professional education in hospitals and healthcare facilities around the world.

The educational aspects of telehealth programs demand the least effort and level of investment of any implementation of the discipline, but the benefits of adoption are immense, and can serve as the building blocks for increased engagement down the road.

Telemedicine actually allows hospitals to bring the education directly into the facility, offering professional training directly from the experts on the newest procedures and protocols, as well as serving as a 24/7 resource always available for consultation.  Bringing this type of program into a hospital not only helps administrators, physicians, nurses, and staff better perform their jobs and offer patients a better standard of care, but also creates champions of the telemedicine services, opening the door to a healthcare ecosystem that is far more responsive to innovation.

Introducing telemedicine to healthcare facilities through educational initiatives is also a great way to align the goals of the hospital and the provider to foster stronger relationships for the future. The facility wants to offer top quality care within the confines of a tightening budget, and the provider wants to help its client hospital save lives while reducing spending in the process to demonstrate its competitive advantage. The educational process is a great way to interface with the effective and efficient solutions that telehealth can offer. It is a major step towards a future where all hospitals have access to the resources they need to operate equally efficiently; a win for patient and provider alike.



A Shifting Attitude

Telemedicine’s role in the current healthcare environment has been blossoming over the course of the past few years, making progress towards the full realization of the field’s potential.  A certain percentage of healthcare professionals are already there; those who have seen telemedicine at work day in and day out already know that we are providing patients with excellent care, mitigating costs to the healthcare system, and saving lives. The challenge remains getting the rest of our industry and our patients up to speed.

Improving care standards and lowering health care costs are their own rewards, but also important is the evident change in the way people think about getting medical treatment. Telemedicine is significantly changing patient behavior. We have heard astonishing figures – flirting with near 100% satisfaction rates – when it comes to positive experiences for both hospital workers and patients.

Presumably, an estimated 20% of the roughly 140 million ER visits that hospitals bear each year are able to be treated virtually. That number jumps to around 70% when considering urgent care centers and primary care physicians. The aforementioned shift in attitude about how to best access care in emergencies and non-emergencies is crucial to opening the door for telemedicine to alleviate much of the burdens these unnecessary visits place on the system. Reducing the stress on physical and financial resources also means better care across the board when patients do come to the hospital.

The speed, efficiency, and improved coordination of care are all great assets for a society battling with the challenges of an inefficient traditional healthcare system. The good news is that the many advantages of telemedicine for payers, providers, and patients are truly beginning to take root with the public, and driving behavior that will lead to even better results down the road.



An Instant Second Opinion

When citizens of a past age first envisioned practical telemedicine in 1924, the images and words on display at Worlds’ Fairs and in magazines likely seemed outlandish – a very optimistic and very distant look into the future. Few could have imagined that technology would make such great strides as to allow the development of a widely implemented network of functioning telemedicine programs less than a century later. Other futurists over the years have dreamed big, pushing forward medical innovation by imagining things like cure-all superdrugs and efficient and clean and precise surgery without a scalpel that are, believe it or not, now becoming reality as well.

As thought-provoking as these examples are, few of these big ideas are in actuality as practical or realistic as the avenues that have been opened for physician collaboration by advances in technology. Collaboration may be a lower impact medical advance than, say, leaps in prosthetics technology, but today, hospital leaders and physicians work considerably more interdependently to improve clinical outcomes and simultaneously combat healthcare logistical challenges and expenses. Increased capacity for collaboration is a major improvement enabled by powerful new telecommunication technologies that allow live consultation between physicians, regardless of distance, and unites the many individuals involved in any one patient’s care.

Telemedicine programs have helped hospital administrators create a better practice environment that results in improved recruiting and retention and fosters a virtuous cycle of better patient care and financial outcomes. One of the greatest advances simply by facilitating two-way conversation for professionals who are used to talking at each other instead of with each other. Collaboration is, in reality, the most tangible of telemedicine’s many benefits.



Affordable Healthcare, On the Go

With the continually rising costs associated with healthcare in the U.S., two new reports suggest the market for telemedicine is poised to grow more than threefold within the next decade thanks to advances in wireless technologies in medical applications.

Mobile technology has paved the way for devices and infrastructure that are capable of mitigating healthcare costs by billions of dollars annually by reducing unnecessary hospitalizations and improving diagnostic and treatment efficiency. These telehealth solutions, many centered around wireless communications technologies, also help improve overall quality and timeliness of care administered, removing the traditional boundaries of distance and time in bringing patients and their doctors together over the web. Telemedicine ensures that patients receive the right care in the right setting to streamline the consultation process and fight excessive costs.

Telehealth has for some time now been proven as an effective means of delivering quality care, particularly to patients in underserved rural areas. Looking towards the future, practitioners are constantly gaining access to more powerful tools and increased mobility, reason to believe that telemedicine will extend more effective, more affordable healthcare to patients everywhere.

Already mobile technologies are steadily revolutionizing healthcare in a multitude of ways. In addition to patient consultation via communications platforms, the latest applications available to practitioners on smartphones, tablets, laptops, and other wireless devices can also help manage patient records, and encourage collaboration with other expert physicians.

Trends towards better technology and increased access to mobile platforms are fueling the rapid growth of telemedicine, which ultimately benefits both patients and providers. Just as mobile phones have given people the power to stay connected without the traditional landline, telemedicine is helping patients everywhere keep in touch with the quality care they deserve.



Looking Backwards to See Ahead – Part 4: Running the Business

This is another blog in a series chronicling the development of AcuteCare Telemedicine (ACT). Much of this reflection involves lessons learned at 2011’s Annual Meeting of the American Telemedicine Association (ATA). What follows is an amalgam of facts, experience and opinions culled from that fantastic symposium and honed by hindsight. Today’s blog will focus on several issues relevant to establishing and running a telemedicine service.

There are myriad of issues confronting physician-entrepreneurs when establishing a telemedicine service. Often these are not immediately evident, although some may be the focus of business development meetings. This blog reviews the topics of business size, communication/documentation, ROI considerations, and coding/billing issues.

The size of a company will directly impact its ability to stay true to its mission. Our firm belief is that the future of telemedicine is in regional providers partnering with both local hospitals and government or not-for-profits. There are larger providers of teleneurology, and their scale may be a corporate advantage; a large staff of part-time physicians to fractionate call burden as well as development of proprietary hardware & software (the cost of which is hidden in a monthly service charge). However, their size is not beneficial to patients and hospitals. In reality, the size of these “McTelemedicine” services paints them as something hospitals fear; impersonal, computerized doctors. The need to focus on healthcare solutions tailored to the specific needs of the healthcare region has been addressed in a recent blog.

Communication must occur in a timely fashion. Otherwise, the telemedicine consult is for naught. Dictating is necessary for documentation of the initial encounter in the permanent medical record, but will be delayed even if transcribed as “priority.” Faxing or emailing is faster, but not always practical. In order to reduce error & liability, especially for critical care issues, direct communication with the local treating physician and nurse is paramount. In cases of acute stroke, providing the medical opinion of whether tissue plasminogen activator (tPA) should be given is sufficient. The actual order for administration of tPA should be given by a physician actually present to review that the dose was properly calculated and administration was expedited.

Return on investment (ROI) will depend on maximizing revenue and avoiding costs – this is relevant to any business. The perspective of both the telemedicine provider and the client hospital must be taken into account. For example, revenue may come to the client hospital through the increased use of value added ancillary services (e.g. radiology, PT, Rehab). One must also identify cost drivers, areas of poor market share (e.g. EMS bypass), obstacles to access, and obstacles to productivity (e.g. difficulty luring a local neurologist because of ER coverage responsibilities). The telemedicine provider may also benefit from the addition of value added services such as reading neurophysiology studies (EEG, sleep, EMG) or lateral expansion through the development of ancillary specialties such as tele-ICU, telepsychiatry or telecardiology.

Coding or billing expertise is not typically required for remote presence consultation, as it is a service provided to the hospital and reimbursed by the hospital accordingly.  Proven increases in revenue and improved patient outcomes absolutely justify this business model. However, in some situations, a physician may bill directly for their services, for example, if the hospital is rural or designated a disadvantaged Metropolitan Statistical Area (MSA). When coding these encounters, Medicare regards telemedicine as face to face time. Using a GT modifier prevents charge bumping if a patient is subsequently seen by a community physician on the same day. Records must also state “Services provided by telemedicine.” One cannot bill Medicare Advantage in an MSA unless there is a contract with the Medicare Advantage carrier.

Medicaid may reimburse encounters within an MSA, but Medicaid does NOT have to follow Medicare rules. Treat them like a third party payer. Keep in mind, the Medicaid staffer handling your reimbursement issues may require education. Finally, follow up telemedicine visits can be billed for 1 visit every 3 days.

Considering these issues, most of which were not immediately evident at the outset, has helped AcuteCare Telemedicine create impact in the market place. ACT not only hightlights the clinical value of its physicians but also addresses the comprehensive business needs of the organizations it serves.