AcuteCare Telemedicine Blog


CMS Expanding Telemedicine Coverage

The Centers for Medicare and Medicaid Services have proposed rules that would provide telemedicine services to nearly 1 million new Medicare beneficiaries.  CMS proposes to increase the number of beneficiaries eligible for telemedicine by modifying their urban/rural definitions and proposes several new reimbursable telemedicine services.

The first change would extend reimbursable telehealth services to “originating sites” serving nearly one million rural beneficiaries living in large metropolitan areas. Currently, Medicare uses a strict county-based classification to enforce its rural-only rule for telemedicine coverage. The new rule would create a more precise urban/rural distinction based on geographically smaller census tracts.

The second proposed change would increase coverage for transitional care management services under Current Procedural Terminology (CPT) codes 99495 and 99496, involving post-discharge communication with a patient and/or caregiver. Reimbursement of these services will help healthcare providers deliver improved in-home care to at-risk beneficiaries and significantly reduce needless hospital readmissions.

Jonathan Linkous, Chief Executive Officer of the American Telemedicine Association cautiously supports the change and in a statement said, “This is one small step in the right direction.  For 15 years the federal government has placed strict restraints on the use of telehealth while employers, private payers, states and many other nations have moved boldly forward, improving the quality and reducing the cost of care. It is time to unleash the power of modern technology and allow Medicare beneficiaries, regardless of whether they live in a rural area, underserved inner-city, in a clinic or at home to be eligible to receive the benefits of telehealth.”

The proposal is currently open for comment and ATA encourages all telemedicine advocates to express their support.  The American Telemedicine Association is the leading international resource and advocate promoting the use of advanced remote medical technologies. ATA and its diverse membership work to fully integrate telemedicine into healthcare systems to improve quality, equity and affordability of healthcare throughout the world.



Collaboration Across the Pond

Relations between the US and the UK are particularly amiable, arguably at an all time high, and moving towards modernity, our cultures have engaged in a ‘give and take’ from one another. However, when it comes to discussion of healthcare policy, our politicians and citizens are often quick to dismiss one another’s perspectives.

Despite the huge disparities in approach, each country’s current desires in regards to changing their healthcare situation are fairly equivalent. Both nations are working towards getting better value from healthcare expenditures, encouraging providers to focus on quality with better incentives, and controlling rising health care costs, regardless of the differences in who is paying.

Telemedicine offers both systems huge advantages in the pursuit of these goals, and the two can learn from one another. In the US, telemedicine has helped curb unnecessary and irresponsible healthcare spending, an important consideration for a nation currently obsessed with combating rising costs detrimental to its economy. Abroad, electronic patient care records are managed efficiently, falling in line with the expectations of the unified, government-controlled National Health Service (NHS) responsible for administrating healthcare.

It is important to keep in mind the great differences in context between the implementation of telemedicine in the United Kingdom and here at home. Of course, the NHS provides citizens with what we have dubbed as “Universal” health care, which is free to the patient at the point of service. In contrast to the Brits’ centrally governed and tax-funded system, care in the US is available through a multitude of competitive providers and is paid for by a patchwork of public and private insurers. The fact of the matter is, telemedicine works as a solution to a myriad of challenges, and both countries are discovering new solutions every day.

Healthcare officials in both countries envision telemedicine playing prominent roles in the future of their respective systems. Perhaps in the short term, this vision will be a common ground on which to open a mutually beneficial dialogue to address the unique challenges facing each nation.



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.



Information in an Instant

There are countless factors that prevent patients from getting to see their doctors. Sometimes the simple fear of ‘getting sick’ and missing time at work or important commitments to our friends and family can stop us. Other times, distance, obligation, or extreme weather conditions can inhibit our ability to get to the hospital, even in cases of emergency. Whether the problem is voluntarily or logistically difficult, doctors and patients have long looked for solutions to these challenges to create a better standard of care.

Thankfully, the 21st century has afforded society some incredible opportunities to mitigate the barriers that stand between people and adequate healthcare services. Many disciplines of medicine are now mobile, capable of patient and doctor interaction regardless of the distance separating them. We have medical devices and software that can perform tasks such as automatically reading and uploading vital statistics for patient monitoring directly into an electronic health record. It has already been widely shown that reducing unnecessary hospital visits results in cost savings for the provider and the patient alike. Now, technologies such as those used in this type of monitoring is also enabling doctors to take better care of patients, helping them maintain an open line of communication, without being too invasive.

Between new monitoring techniques and the proliferation of location-based services, doctors can now effectively keep 24/7 tabs on at-risk patients, and might even be capable of sending the appropriate emergency response to victims of heart attack or stroke. It is mind-boggling to think that through powerful new devices and lightning-fast internet infrastructure, a doctor could actually know a stroke is progressing before the patient does.

With the prominent role we as a society assign to technology, it seems only fitting that it is now working to help save our lives. Physicians 50 years ago could hardly have envisioned these futuristic capabilities; it is an extremely exciting time to be practicing medicine on the cutting edge of technology.



What Can the Third World Teach Us About Telemedicine?

Telemedicine and mHealth solutions represent the most recent advances in medical history. As futuristic as a patient consulting a doctor from across the world via communications technology may seem, telemedicine is founded in addressing some fundamental challenges that are not unique to the 21st century.

Citizens of developing nations are a glance into the past of the modern world. Limited resources leave these countries facing 3 primary obstacles to proper care that telemedicine is working to overcome:

Lack of doctors: Lower education standards lead to fewer total doctors, leaving some large geographical areas with few or no doctors.

Lack of access: Citizens cannot get to doctors due to their sickness or difficulties with limited transportation options.

Lack of money:  Most citizens simply cannot afford to pay for healthcare.

Compare these points with realities for many Americans:

Lack of doctors: Currently, there are an estimated 954,000 total doctors in the U.S., and that number is projected to constitute a shortage of as many as 150,000 in 15 years. Certain specializations are particularly poorly represented; for example, there is currently roughly one geriatrician for every 2,620 Americans 75 or older, and is only getting worse as senior citizen numbers rise. This ratio could drop to as few as one geriatrician per 3,798 seniors by 2030.

Lack of access: The continental U.S. features many large rural regions, leaving hundreds of millions of citizens at a significant distance from an adequate acute care hospital.  Many people, particularly older citizens, require frequent visits to multiple doctors due to co-morbidity of diabetes, hypertension, and cardiovascular diseases. Transporting elderly or infirmed individuals to a physician is becoming increasingly demanding, with rising fuel costs. In addition, specialist doctor visits can often require weeks or months of wait time for schedule availability.

Lack of money: While average income is much higher in the U.S. than in developing nations, rising healthcare costs mean Americans spend a greater percentage of their earnings on healthcare, with healthcare expenditure constituting as much as 15% of GDP. This number is also expected to rise unless dramatic policy changes or significant shifts in healthcare protocol occur.

In reality, the challenges facing healthcare are unchanging. Unlike in the past, modern technology is now paving a path for healthcare providers to tackle the task of overcoming these obstacles. Best of all, as technology moves forward, the same telemedicine solutions that can solve problems in developed countries like the U.S. can eventually be extended to aid citizens of underdeveloped nations. Telemedicine is building a healthier, more connected world.

 



US Government Stands Behind Telemedicine

The USDA has announced its renewed support for the development of telemedicine programs in rural areas. The latest round of funding is part of the agency’s Distance Learning and Telemedicine Loan and Grant Program (DLT), designed specifically to “meet the educational and health care needs of rural America.” Through loans, grants and loan/grant combinations, advanced telecommunications technologies such as those utilized in the practice of telemedicine provide enhanced learning and health care opportunities for rural residents.

The agency has long stood behind telehealth initiatives, touting the abilities of telemedicine to increase citizen access to quality healthcare while simultaneously opening lines of communication to enhance educational for hospitals and schools in underserved areas. Practitioners in the field of telemedicine share in the ideology that where a patient chooses to live should not affect the quality of care they can access.

The upgraded equipment and professional development that will result from the grants will help extend telemedicine services to a larger network of rural dwellers. As telemedicine networks grow, the benefits will continue to grow, both in terms of both improved patient outcomes and reduced healthcare costs.

 



Helping Healthcare Go Green

Telemedicine has leveraged technology to help hospitals overcome challenges associated with staffing and transportation extend higher quality healthcare to patients, regardless of their location, while simultaneously reducing costs. Now, we are beginning to understand that telemedicine not only helps hospital facilities run leaner; it may also help them be greener.

Hospital facilities are traditionally located in areas of higher population, often far away from patients living in rural communities. The transfer of these remote patients to hospitals for inpatient treatment demands relatively high energy consumption. With a foreseeable increase in numbers of patients requiring care in the future, these costs can be expected to rise if left unaddressed.

Within the context of changing environmental policy, increased focus must be placed on reducing emissions and energy usage in healthcare policy. Telemedicine has demonstrated positive effects, creating a more environmentally sustainable process by improving inpatient treatment in local community hospitals and improving monitoring of complex diseases in outpatient settings, avoiding unnecessary hospital admissions.

Physicians have traditionally placed a priority patient care over any environmental responsibility, but telemedicine offers opportunities to minimize environmental impact while developing a higher standard of care across the country. By combating energy consumption, telemedicine is improving not only the health of patients, but also the planet.