AcuteCare Telemedicine Blog


Employer Sponsored Telemedicine Programs On The Rise

A new survey by Towers Watson, a global professional services company, reveals that telemedicine could provide billions in healthcare savings each year as employer-sponsored telemedicine programs increase. The availability of telemedicine represents significant cost savings for employers by precluding lost time and productivity as workers must go off-site for office and face-to-face care. The savings for employees with such convenience should also not be overlooked.

“While this analysis highlights a maximum potential savings, even a significantly lower level of use could generate hundreds of millions of dollars in savings,” said Dr. Allan Khoury, a senior consultant at Towers Watson. “Achieving this savings requires a shift in patient and physician mindsets, health plan willingness to integrate and reimburse such services, and regulatory support in all states.”

The results of the study are not surprising to many of those who have been advocating an aggressive expansion of telemedical technology in order to address rising healthcare costs, expand access to medical specialists for rural patients and to head-off a predicted physician shortage. As patients and caregivers become more familiar with how and when new communication technologies can improve the delivery of medical care for a significant number of medical services, the reluctance associated with foregoing face-to-face encounters with the family doctor and replacing it with a virtual experience is beginning to fade. Patients who need ordinary medical treatment and consultations are gaining significant cost and convenience benefits with the new relationships. Once patients become familiar with the virtual experience, the vast majority are responding very favorably.

Insurance providers and employers are also joining the chorus of support. The Towers Watson findings indicate that 37 percent of those employers surveyed expect to offer their employees a telemedicine alternative to traditional in-office or emergency room healthcare by the end of next year. It’s an increase of 15 percent of employers who currently offer their employees such options. The move by employees to utilize the employer telemedicine programs is progressing at a slow pace however, with only 10 percent of those eligible taking advantage of the opportunity.

As the benefits and availability of telemedicine and telehealth services grow, the numbers who choose to participate is expected to rise.  “With both insurance companies and employers encouraging its use, telemedicine is going to have a growing role in the spectrum of health care service delivery,” Dr. Khoury says.

 

 

 



Telemedicine and the Medical Licensing Debate

The number of patients served by telemedicine has grown from a few thousand in the mid-1980s to an estimated 10 million people today. The majority of the growth occurred in the last decade, according to the American Telemedicine Association. Despite the rapid adoption of telemedicine practices by healthcare institutions, practitioners must meet individual state medical licensing requirements.

Some states argue that easing licensing requirements could jeopardize patient safety. If doctors practice without obtaining a license in that state, regulators maintain that they have no power to conduct an investigation or explore a consumer complaint. In addition, doctors would not benefit from any legal protections the state may have against malpractice lawsuits. Advocates of telemedicine argue that because doctors take standardized national exams, with many requirements set by federal agencies such as the U.S. Department of Health and Human Services, states should recognize other state licenses. The debate is not without merit, on either side of the issue.

In a time past, interstate commerce experienced similar obstructions to improving the nationwide consumer product and service delivery model. Implemented in an era before advanced transportation technology and the interstate highway system carriers of goods and services across state lines were required to have individual state licenses, adhere to 50 different sets of roadway regulations and pay transportation taxes and fees in every state where transportation service was provided. The very formidable barriers to streamlining interstate commerce were successfully circumvented by a new national regulatory and licensing system. The move successfully addressed the individual state concerns and resulted in massive improvements to the nationwide delivery of good and services to all consumers, no matter where they resided.

Today, as major telecommunications and health care firms look to create nationwide telemedicine businesses, state medical licensing boards are set to consider an “interstate medical licensure compact” that would give doctors and patients legal protections in any state that signs on. The proposal, to be considered at the annual meeting of the Federation of State Medical Boards (FSMB) this month, would expedite the licensing process for doctors who want to practice across state borders. The compact, which was developed by a task force of 22 state medical boards, may represent the first step in resolving the issue. Lisa Robin, chief advocacy officer for the federation, expects there will be some early adopters. “I believe there will be some proliferation.”

The medical industry is facing significant challenges in the coming decades, such as physician shortages, spiraling costs of care, specialist accessibility and the entry of millions of new patients to the market as the Affordable Care Act (ACA) is fully implemented. In order to implement a long-term solution, technology standards and medical licensing requirements share equal importance in the debate.



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.



Technology is Advancing the Practice of Telepsychiatry

Telepsychiatry and other long-distance options for providing mental health care can help overcome problems related to location and distribution of specialty mental health services but should not be seen as a panacea for delivering care to rural areas in the United States, reported a research and policy brief from the Maine Rural Health Research Center. “Telemental health” (yet another new term) once depended on heavy-duty audio and video technology based in fixed studios to initiate care. Despite this coarse beginning, advances in computer technology and its near-universal adoption have resulted in improved delivery of Telepsychiatry and made it more cost effective and available to a wider audience, however, some non-technical hurdles remain to be cleared.

Until recently, “Telemental health” services were most commonly provided by psychiatrists, clinical psychologists, clinical social workers, and psychiatric nurse practitioners, but now a pilot project begun at one critical-access hospital in collaboration with a psychiatrist and specialty mental health staff at a community mental health center has expanded to five additional hospitals. This system provides round-the-clock crisis evaluation and support at the hospital emergency departments and some say that “Telemental health” enabled them to provide services to rural persons that otherwise would not be available, but some nontechnical barriers such as poor Medicaid and commercial reimbursement rates, recruitment and retention difficulties, high numbers of patients without insurance, and high no-show rates serve as a drag on expansion of current programs.

The barriers experienced with “Telemental health” expansion is shared by other medical service disciplines seeking to enter or expand the utilization of telecommunication technologies that promise to revolutionize the delivery of medical care in the United States and across the world.  While progress is being made to overcome many of the most significant structural road blocks to expansion and adoption of these new technologies, much remains to be done to clear the path to a new medical care delivery model.

Maintaining a consistent push to encourage state and congressional representatives and health insurance industry leaders to move forward and embrace the revolution in healthcare must continue until each barrier is removed or neutralized.  The promise of delivering better, less expensive and more available medical care to millions of patients across the country depends on these continued efforts progressing and succeeding.



Advancing the Benefits of Telehealth and Telemedicine

Dr. Teresa Myers, a family practice physician in Copley, Ohio, describes what she can see on her computer screen during a telehealth conference. “You know what HD television looks like. You can actually see the pimples on the actors’ faces,” she says. “I had a patient who was able to shine her iPhone flashlight to the back of her throat. I could see the exudates [pus-like fluid]. If you see that, you can be pretty sure.” A few more questions, as well as having the patient take her temperature and feel and describe her lymph nodes, and Myers felt confident diagnosing strep throat and prescribing an antibiotic.  The consultation started less than five minutes after the patient logged in, cost $49 and lasted 10 minutes. The patient never left home, learned a few things about examining her own body and, two days later, said she felt much better when Myers followed up.

The rural health care workforce is stretched to its limits in most states. Despite programs operated by state, federal and local governments aimed at recruiting and retaining primary care professionals to these areas, the need outpaces the supply in many communities. Also, many of the current primary care physicians are nearing retirement and the numbers to replace them are insufficient.

For many states with large rural populations, telehealth has emerged as a cost-effective alternative to traditional face-to-face consultations or examinations between provider and patient. Telehealth is the use of technology to deliver health care, health information or health education at a distance. Real time telehealth communications allows the patient and physician to connect and interact through video conferencing, telephone or video health monitoring device.  Store and forward telehealth refers to the transmission of data, images, sound and video from one care giver to another.

Forty-two states currently provide some form of Medicaid reimbursement for telehealth services and 17 states require private insurance companies to cover telehealth services. While individual states appear to be well out in front of the federal government on supporting telehealth innovation, the federal government is finally moving to catch-up with the recent introduction of “The Telehealth Enhancement Act of 2013 (H.R. 3306).”  The bill promises to strengthen Medicare and enhance Medicaid through expanded telemedicine coverage and calls for the adoption of payment innovations to include telehealth and to make other incremental improvements to existing telehealth coverage. Another Congressional bill, “TELE-MED Act of 2013” (H.R. 3077) would permit certain Medicare providers in a state to provide telemedicine services to Medicare beneficiaries in a different state.

The convergence of medical advances, health information technology, and a nationwide broadband network are transforming the delivery of health care by bringing the health care provider and patient together in a virtual world, especially those in disadvantaged areas. Telemedicine has the potential to improve health care access and quality to patients in urban and rural America alike, but a variety of barriers, such as reimbursement and licensing issues, continue to stand in the way of more aggressive, widespread adoption.

The recent progress by state and federal governing bodies to recognize the significant advantages of increased telehealth services for all Americans with the introduction of new and meaningful legislation to address and remove established barriers to expansion, is encouraging to those in the health care community whose fundamental goal is to provide the best quality medical care to their patients no matter where they live.



The 2nd Annual Alabama Rural Health & TeleHealth Summit

The Alabama Rural Health Association (ARHA) and the Alabama Partnership for Telehealth (APT) will be sponsoring the 2nd Annual Alabama Rural Health & Telehealth Summit on October 16th thru the 17th in Prattville, Alabama.  The conference provides an excellent opportunity to learn about the current uses and capabilities of telehealth and telemedicine and will include updated information on the Affordable Care Act (ACA) and more specific information on the Health Insurance Exchange program, Navigator program, and Accountable Care Organization program.  Alabama Governor Robert Bentley is scheduled to present the opening address.

Dr. Matt Gwynn, Acute Care Telemedicine, the leading practice-based provider of Telemedicine services in the southeast, will be joined by Levonne Outlaw, Southeastern Alabama Medical Center (SAMC) Stroke Network Coordinator, Dr. Jason Deleon,  SAMC Emergency Medicine physician and Cecilia Land, Director of Rehab Services, in presenting a session titled, “Reaching Out to Alabama with Telestroke Services.”  Dr. Gwynn will review recent patient success stories related to ACT telestroke services, the successful working relationship with SAMC and the future of the telestroke network. The SAMC Network currently includes SAMC and five “spoke” hospitals with plans to expand to additional network partners throughout the Florida Panhandle and rural southwest Georgia.

Featured speakers for the Summit include Davis Lee, National Rural Health Association (HRHA), Martin Rice, specialist in Electronic Health Record implementation and Gary Capistrant, Senior Director, Public Policy at the American Telemedicine Association.

Alabama Partnership for TeleHealth, (APT), is a charitable nonprofit corporation focused on increasing access to healthcare through the innovative use of technology and dedicated to providing an opportunity for TeleHealth services to expand and provide greater access to healthcare to all of Alabama.

The Alabama Rural Health Association (ARHA) is focused on the preservation and enhancement of health to rural citizens in all 67 counties of Alabama. The Summit partners share a common belief that Telehealth holds an exciting promise for providing increased access to quality care for rural Alabama and that TeleHealth is changing the way we think about health and the health care delivery model.

The Summit provides a great opportunity for health care providers to join together in collaboration to improve the health care system.    The Alabama Rural Health & Telehealth Summit 2013 will be held at the Marriott-Legends at Capitol Hill, 2500 Legends Circle, Prattville, Alabama. To find out more about exhibiting or attending the conference visit www.alabamatelehealth.com.



Positive Patient Outcome Advances the Telemedicine Delivery Model

Recently a team of researchers from UCLA completed a major study on the use of tissue plasminogen activator, or tPA, on stroke victims within 4.5 hours after the stroke occurs. That study of more than 50,000 stroke patients, as reported in a recent issue of JAMA, The Journal of the American Medical Association, confirms that the sooner tPA is administered, the better chance of recovery.  In response to the study, AcuteCare Telemedicine (ACT), an Atlanta-based company that’s billed as the largest practice-based provider of teleneurology is making an aggressive push to help smaller hospitals and networks that don’t have immediate access to neurologists.

Their efforts have proven to be life saving for one Ozark, Alabama resident and recent stroke victim.  The collaboration between ACT and the Southeast Alabama Medical Center (SAMC) is having its desired effect for SAMC patients, providing once unavailable, advanced life saving treatments to stroke patients. The Stroke Care Network, established in Dothan, Ala., in collaboration with ACT, the Southeastern Alabama Medical Center Foundation and the Alabama Partnership for Telehealth provides stroke services for a 240-square-mile swath that includes southeast Alabama, southwest Georgia and the Florida Panhandle.

The collaboration was initiated when Cecilia Land, SAMC’s division director for rehabilitation services discovered an increase in the areas mortality and morbidity due to stroke. “We recognized an immediate need to establish a stroke care network, providing patients with access to 24×7 teleneurology,” said Land.  SAMC officials hope to add more “spokes” to the network, in the form of hospitals and clinics, and also want to use the network to educate communities on the importance of wellness and identifying precursors to a stroke.  Dr. Keith A. Sanders from AcuteCare Telemedicine hopes to extend ACT’s telemedicine platform to other specialties, such as telepsychology, and he expects more hospitals and health networks will buy into the system as executives see the benefits of sharing specialist services without having to house them on-site.

This most recent life-saving patient outcome from the collaboration between ACT and SAMC is proof that the new telemedicine health care model is an excellent vehicle to advancing the availability and quality of telestroke care to SAMC patients and to underserved patients all around the country.