AcuteCare Telemedicine Blog


Telemedicine Achieves Its Potential for Parkinson’s Patients

Ask any patient suffering from chronic disease and they often will tell a story of isolation, uncertainty and frustration over the debilitating effects of their disease. Many times the focus of their complaints is not being afforded easy access to specialized care and consultation with caregivers. While significant inroads have been made in the treatment options for chronic maladies like Diabetes and Parkinson’s disease, gaining routine, daily access to those ground breaking discoveries is out of the reach of many sufferers.

Researchers are looking at how modern communication technology, coupled with the latest techniques in treating Parkinson disease, can revolutionize the quality of care for sufferers of the chronic neurological disorder. “We are looking at quality of life, quality of care and reducing the burden on healthcare providers”, says Dr. Ray Dorsey, co-director of the Center for Human Experimental Therapeutics at the University of Rochester (N.Y.) Medical Center. “Imagine if you thought there was a possibility you had Parkinson’s disease, but you lived 100 miles or more from the nearest medical center with a qualified neurologist. You’re faced with at least a couple of hours of driving, of navigating an unfamiliar urban environment, of parking and walking—and that’s assuming you’re able to find a neurologist within driving distance to begin with. Now think about how easy it is to buy a book or a pair of shoes online. The two should not be so different.”

Preliminary results of the Connect.Parkinson project, the nation’s first randomized clinical trial of remote treatment of Parkinson’s disease, indicate the benefits of virtual treatment for patients and caregivers alike. A recent report on the initial results of the 18-state, Connect.Parkinson project reported that 95 percent of Parkinson’s patients completing telehealth visits have experienced an increased proportion of the time with a healthcare professional of 89 percent; up from 25 percent for those opting for traditional in-person encounters.

The National Parkinson Foundation is committed to supporting efforts to demonstrate how telemedicine can enhance the delivery of care to people with Parkinson’s. Studies are indicating that telemedicine care, often delivered in the patients home, is just as good as care received at a brick and motor medical center. The fact that diagnosing and monitoring the progression of Parkinson’s disease and other movement disorders is based almost entirely on visual observation makes Parkinson uniquely suited for virtual care technologies. Christopher Goetz, MD, a leading expert on movement disorders and director of the Parkinson’s Disease and Movement Disorders Center at Rush University Medical Center says, “Ninety-five percent of the information I gather is visual. Thus, with telemedicine visits where I can see and hear my patient right in front of me on the computer screen, there is no decline in the quality of information I gather.”

Rush is located in the state of Illinois which is among those states not yet mandating payers to provide payments for telemedical services. But according to Dr. Brian Patty, Rush’s chief medical information office and chairman of Rush’s Telemedicine Steering Committee, the Medical Center has several telemedicine pilot projects underway that can likely have significant impact on Parkinson patients.

In New York, researchers at The Rochester Center for Human Experimental Therapeutics, are developing and testing mobile apps that will help Parkinson’s patients track metrics such as dexterity, balance, gait, voice patterns and cognition, then send readings to researchers.

After decades of promises, telemedicine is delivering on its promise to increase access to quality, specialty care to improve patient outcomes.



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.



The Era of Resisting Telemedicine is Fleeing

Despite the promise of significant consumer benefits of access and costs and the overall growth of Telemedicine, many patients and physicians are slow to adopt new communication technologies in the delivery of healthcare. A recent article in Medical Economics News reported that “A HealthMine Survey of 500 consumers who use mobile/Internet-connected health applications finds that 39% still have not heard of telemedicine, and only one-third of respondents say their health plan offers telehealth as an option.” And while many patients have not yet signed on to telehealth services, nearly three quarters of patients are interested in using it in place of in-person medical appointments. Could it be that the slow progression of patient participation may be due to resistance and lack of participation from care providers?

One of the most prolific reasons many providers resist the technology is the concern that patients would be unwilling to replace traditional face-to-face physician encounters with a virtual relationship and that many consumers would be fearful of the technology, particularly those among the growing number of “Baby Boomer” patients. But in a recent Georgetown University study, the results indicated that more than half of the aging generation preferred to use this technology. And among those 34 years of age and under, 60 percent desired a virtual interaction with their physician.

Some of the complaints from cautious physicians revolve around the complexity and cost of technology hardware and software and the difficulties in merging new platforms into existing operations, particularly syncing virtual experiences with current EHR systems. Ongoing design improvements in the technology and simpler user interfaces are driving down cost and simplifying required functions. The reality today is that telemedicine improves the bottom line for most medical practices while reducing appointment management and patient flow issues.

As legislatures across the country continue to make progress on modifying existing regulatory barriers and concerns involving payment parity, payer participation and individual state licensing and credentialing, many early telemedicine supporters are beginning to see the light at the end of the increased adoption tunnel. For those providers who continue to resist the trends of virtual medical technology, the time is nearing to overcome the natural tendency to resist and fear change. The simple truth is patients prefer and want telehealth choices and the technology is here to stay.



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.



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!



Legislator Introduces New Bill to Remove Medicare Telehealth Barriers

Senator Roger Wicker, R-Mississippi has introduced legislation that seeks to remove barriers to telehealth services in Medicare. Medicare fee for service (FFS) does currently provide reimbursement for telehealth services to patients at rural area health clinics, however, current law limits telehealth reimbursement to rural areas, disallows the storage of information to physicians via electronic medical records, email and other communications technology and doesn’t reimburse telehealth services provided by physical or occupational therapists or for physicians who treat patients within their own home.

The bill, Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, attempts to broaden telehealth services across the country and offer an added opportunity to serve the needs of the elderly. The bill, which has broad bipartisan congressional support, would allow Medicare patients to use video conferencing, remote patient monitoring and technology to transfer patient data and will expand Medicare reimbursement of telehealth consultations and remote patient monitoring with fewer restrictions.

“This legislation has the potential to remove barriers to new healthcare delivery models that promote coordinated and patient-centered care. Importantly, the bill aims to maintain high standards whether a patient is seeing a physician in an office or via telemedicine,” said American Medical Association (AMA) President Steven Stack. “Telemedicine can strengthen the patient-physician relationship and improve access for patients with chronic conditions and limited access to quality care. The AMA’s guiding principles on telemedicine seek to foster innovation while promoting quality care.”

According to an analysis by the health-care consulting firm Avalere, expanded Telehealth services could save $1.8 billion dollars in medical cost over the next ten years by removing the current restrictions, and would make healthcare more available for patients who often struggle with access to the latest high quality care.

“We strongly believe in the importance of implementing processes and procedures for telemedicine. Our experience working with regional hospitals as well as enterprise level healthcare systems, has demonstrated that effectively executed telemedicine programs can drive significant value,” comments Dr. James Kiely, Partner, ACT. “In our most recent peer-reviewed article, we’ve proven that a telemedicine system can produce meaningful improvement in markers of telestroke efficiency in the face of rapid growth of a telestroke network.”

With a vastly aging population, Federal and State legislators must continue to make improvements in access to quality healthcare for Medicare patients even if it means establishing new legislation designed to govern telemedicine responsibly.