AcuteCare Telemedicine Blog


Telemedicine Finding Support Among the Young and Affluent

According to a new RAND Corporation study, people who are younger, more affluent and do not have established health care relationships are more likely to use a telemedicine program that allows patients to get medical help by talking to a doctor over the telephone. Patients who used the service suffered from a wide assortment of acute medical problems such as respiratory illnesses and skin problems, and researchers found little evidence of misdiagnosis or treatment failure among those who used the service.  The findings, published in the February edition of the journal Health Affairs, are from the first assessment of a telemedicine program offered to a large, diverse group of patients across the United States.

“Telemedicine services such as the one we studied that directly links physicians and patients via telephone or Internet have the potential to expand access to care and lower costs,” said Lori Uscher-Pines, lead author of the study and a policy researcher at RAND, a nonprofit research organization. “However, little is known about how these services are being used and whether they provide good quality care. Our study provides a first step to better understand this growing health care trend.”

Among patients studied, the most common problems treated during a visit were acute respiratory conditions, urinary tract infections and skin problems, which accounted for more than half the cases. Other frequent reasons for were abdominal pain, back and joint problems, viral illnesses, eye problems and ear infections. More than a third of the visits occurred on weekends or holidays. Interest has grown in telemedicine programs because of the shortage of primary care physicians, which will likely worsen as more Americans acquire medical coverage under the Affordable Care Act. Telemedicine is one of the alternatives touted as a way to better provide primary health care without greatly expanding the number of doctors.

The implementation of the Patient Protection and Affordable Care Act is leading to increased demand that physicians interact with more patients, pointing to telemedicine as a potential solution. Most physicians believe that the quality of patient care is not compromised by telemedicine because it is delivered through different channels. Physicians can consult with more patients, and patients can meet with their physicians in a shorter time period. In terms of economic advantages, telemedicine can save a great deal of time for patients who otherwise would have to leave work, and it can reduce ER visits. According to Kenneth McConnochie, M.D., M.P.H., director of the Health-e-Access Telemedicine Program and professor of pediatrics at the University of Rochester Medical Center in Rochester, N.Y., parents with young children consider time and lower expenses to be valuable commodities. By increasing its use of telemedicine, the medical center reported a 22 percent reduction in ER visits among schoolchildren. McConnochie pointed out that the average telemedicine visit costs $75 compared with $750 for a typical ER visit.

“The people who are attracted to this type of telemedicine may be a more technologically savvy group that has less time to obtain medical care through traditional settings,” said Dr. Ateev Mehrotra, a RAND researcher, co-author and an associate professor at the Harvard Medical School. However, researchers caution that more research is necessary to further assess the quality and safety of telemedicine services and to more adequately address concerns that expanded use of this type of telemedicine may lead to fragmentation of care. Still, the general consensus among patients and parents who used the service appeared to indicate that they believed that accessing medical services via telemedicine technology was much more convenient, saving them time and money.  For these consumers the convenience factor dominated over other concerns.



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.



Think of Your Brain!

It is without a doubt the most vital organ in the human body, but too often we neglect the importance of taking good care of our brain. The development and organization of the brain are incredibly complex, but the intricacies of this central body belie the simplicity of its proper day to day caretaking. We only get one – why not give some thought (pun intended) to it.

Prevention of traumatic head injuries is likely the most obvious consideration for avoiding significant damage to the brain. Unfortunately, we cannot always predict when an accident might occur, but we can take basic steps like fastening our seat belts while riding in automobiles and wearing helmets when engaging in physical activities carrying risk of trauma. Beneath the skull, we must be concerned with degenerative disorders of the brain affecting motor skills and cognition, such as Alzheimer’s Disease and Parkinson’s. Depression and anxiety also afflict millions of individuals across the country. It is important to remember that although our fast paced, high-stress lives can seem overwhelming, these conditions are chemical, and there are measures we can take to mitigate their negative effects.

Perhaps the most severe threat to the brain is stroke and other cardiovascular disease. The American lifestyle has taken a significant toll on the health of the blood vessels that deliver vital oxygen and nutrients to the brain. We have seen it most exaggerated throughout the southeastern US, a part of the country known as the ‘Stroke Belt,’ where residents face significantly higher rates of stroke morbidity and mortality.

The experts offering advice to citizens on how to minimize their risk of stroke sound like a veritable broken record; sleep more. Eat better. Exercise. Although stroke care has made huge advances in technology and technique over the course of the past decade, there is truthfully no more powerful plan of action than that of prevention. Telemedicine may soon be able to play a bigger role in opening lines communications between physicians and patients at risk of having a stroke, helping them take the necessary steps to avoid an emergency situation where the health of their brain and their life are in danger. As neurologists become more familiar with the advantages of new telemedicine technologies, they are realizing that the “ounce of prevention” is more readily available than ever before.



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.