AcuteCare Telemedicine Blog


Beam Me Up, Doc!

Telemedicine, the rapidly developing application of clinical medical services utilizing today’s advanced communication technology, is moving forward at an escalating pace. Challenges to its wide spread implementation are being overcome with advancements and refinements to the technology. As physicians and patients concerns over the effectiveness of care and information security are addressed, the promises of lower cost, more accessible, quality, health care conducted via the internet is gaining popularity among healthcare providers and patients alike.

With the concept of telemedicine now having been successfully established, AcuteCare Telemedicine is utilizing the modern communication technology to enable personal neurology consultation when doctor and patient are in different locations. ACT makes urgent stroke care accessible for more patients and cost-effective for hospitals and clinicians. Expanding clinical services where physicians electronically treat patients directly without a clinician being present with the patient is the most logical next step in the technology’s progression.

Patients and physicians in Hawaii are now able to enroll in Hawaii Medical Service Association (HMSA) Online Care program where patients receive care from participating doctors who are scheduled to be reachable at that moment. HMSA says thousands of patients have registered, and in New York, about 10,000 individuals, most of them residents of the New York metropolitan area, can already get an online emergency consultation with emergency room physicians.

Jay Sanders, president emeritus of the American Telemedicine Association says, “Probably the most powerful aspect of telemedicine is improving access and improving the convenience of a lot of elements of healthcare, so, whether you’re talking about folks who would have a hard time getting to a specialist or whether you’re talking about someone who is in a jam and needs to see a doctor before they go on a business trip, telemedicine clinics are very valuable. These technologies are unlikely to replace office or hospital visits entirely”, says Sanders. “But they are tools physicians can add to an evolving ‘electronic black bag,’ as he calls it—the updated equivalent of the battered leather case brought along on house calls in a bygone age.



Investing in People

Telemedicine has garnered more attention as of late as a truly game-changing emerging field on the cutting edge of healthcare. Perceptions of the field have become increasingly favorable, but there is still a long road ahead to becoming part of the mainstream lexicon of medicine for patients and providers.

Presently, one of the most significant barriers to entry for new companies in telemedicine is the level of investment required on the part of potential client facilities. Revolutionary technology does not typically come cheap, and as healthcare spending continues to swell (albeit at a slower rate than previously), most facilities are working diligently to combat rising costs rather than add new programs to already bloated budgets.

The good news is that practical new technologies, regardless of how disruptive or expensive at the outset, have a habit of eventually finding their way into adoption. A common adage proclaims that every few years, the power of technology doubles and its price tag is halved. This implies that facilities which have temporarily chosen to forego the extensive advantages that telemedicine programs offer based upon steep startup costs will ultimately find the same solutions to be far more cost effective in the not-too-distant future. However, late adopters of telemedicine services do run the risk of losing their competitive edge. This is especially true in light of the rapid changes ahead in the healthcare landscape; the integration of telemedicine can make a hospital more independent of, or attractive to, consolidation by larger healthcare systems, depending on the goals of the client.

When considering teleneurology as a discipline in particular, hospitals must recognize that an investment in telemedicine is far more than an investment in the newest, best equipment; it is the foundation of a relationship with physicians who are among the most knowledgeable and experiences practitioners in their field. AcuteCare Telemedicine is truly technology- agnostic, meaning that regardless of the price tag of the machines that we leverage to connect with a facility’s patients or staff, a partnership with our physicians means that behind the machinery is the expertise needed to drastically improve the quality of care a patient can receive. We place value in finding quality tools to accomplish our mission, but our accessibility is by no means restricted by them.

Many healthcare leaders are still hesitant to make the investment in something new, but the time has come that the highest level of expert care be available to everyone, everywhere. It is our vision that hospital facilities will share in our agnosticism towards technology and invest in the people who will improve healthcare’s next generation.



ACT Partner Taylor Regional Hospital Embraces Technology for Better Care Standard

AcuteCare Telemedicine (ACT) partner Taylor Regional Hospital in Hawkinsville, GA is on the cutting edge of revolutionizing healthcare in underserved areas in rural parts of the Southeastern US.

Lacking the fiscal and logistical resources to implement the comprehensive services found at larger facilities in urban centers, Taylor Regional has openly embraced a wealth of new technologies to drastically improve the quality of care it offers patients within its surrounding communities.

Choosing ACT’s 24/7 teleneurology services was an elegant solution to a major deficiency facing the hospital. Taylor Regional has no neurologists on staff, and the nearest available specialists are located more than an hour away. Prior to the partnership with ACT, the hospital lacked the capability to effectively diagnose and treat stroke-causing clots, often having to transfer patients to a larger hospital, compromising crucial ‘door-to-needle’ time and reducing potential hospital revenues.

Through the adoption of beneficial programs such as the telemedicine services offered by ACT, the hospital has not only taken strides forward in treating patients internally, but has also enhanced communications with other facilities, connecting with other physicians for consultation and collaboration as well as streamlining transfer processes to ensure patients receive timely and expert care.

Most recently, the teleneurology services provided by ACT resulted in the administration of tissue plasminogen activator (tPA) in two separate cases of acute stroke at the facility in the month of August 2012. The two successful administrations of the clot-busting agent are a significant achievement, serving as a milestone for a teleneurology partnership that has now successfully extended this potentially-life saving service to residents of the counties surrounding Taylor Regional.

“We are very pleased with our partnership with ACT. The neurologists are extremely professional and eager for our telemedicine program to make a real difference in the care we are able to extend to our stroke patients,” commented Lynn Grant, Emergency Room and ICU Nurse Manager, Taylor Regional. “ACT is available 24/7, taking the time not just to be there for the patients, but for our physicians, nurses, and staff, answering questions and educating about the technology and techniques that are helping us save lives. Having this service is very rewarding.”

“Taylor Regional Hospital is on the cutting edge of emergency stroke care in rural Georgia. ACT has been particularly impressed with their clinical judgment, leadership and organization,” said Dr. James Kiely, Partner, ACT. “Their community is well served.”

For more information about ACT, visit www.acutecaretelemed.com.



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.

 



The Times, They Are A-Changin’

Health care reform must not add to our deficits over the next 10 years — it must be at least deficit neutral and put America on a path to reducing its deficit over time. To fulfill this promise, I have set aside $635 billion in a health reserve fund as a down payment on reform. This reserve fund includes a number of proposals to cut spending by $309 billion over 10 years –reducing overpayments to Medicare Advantage private insurers; strengthening Medicare and Medicaid payment accuracy by cutting waste, fraud and abuse; improving care for Medicare patients after hospitalizations; and encouraging physicians to form “accountable care organizations” to improve the quality of care for Medicare patients.

            President Barack Obama

June 3, 2009

By the end of this decade, medical care will be delivered as never imagined by more than a few. No longer will you pay a doctor for his services. Instead, you will belong to one of thousands of Accountable Care Organizations (an ACO).

Your money will be paid to an entity whose job it will be to provide medical services to you and thousands of others from cradle to grave. You will pay a fixed fee that will be pooled and distributed as determined by the ACO to providers such as neurologists and other physicians. If they meet certain criteria, like fewer hospitalizations and lower medication costs, they will get bonuses. If not, they will simply be fired.

You will likely be tied to a long-term contract in order to control your behavior so that you get healthier and the ACO can show benefit to regulators. Otherwise the lengths that the ACO will go to in order make you healthier -like education or fitness programs-will show up on some other ACO’s achievement table. There are a few entities that approximate this type of program, such as Kaiser Permanente and the Harvard Pilgrim Plan, but unlike with future ACOs, participants float in and out, which is a disincentive for investing money in patients.

How will this affect the delivery of neurological care? According to the American Academy of Neurology, only about 7000 neurologists actually practice in the US, about 25 per million people. More and more are dropping out of hospital work because of high medical liability risk, poor reimbursements and the high demand in office practices because of the shortage. Consequently, neurologist availability will be a challenge for ACOs as Americans develop stroke and other diseases of the elderly in ever greater numbers. Not all ACOs, will be able to employ them, especially in smaller towns and rural areas.

Because nearly all of neurology relies heavily on patient history and observational exams (what the neurologist sees rather than touching or listening to the organs) and because treatments rely almost solely on medications rather than operations or procedures requiring proximity, telemedicine offers an excellent solution.

With salary, benefits, and other expenses, the cost of recruiting and retaining a neurologist is extremely high. If the neurologist is paid based on membership figures, a smaller ACO may not be able to support even one neurologist to handle the clinic, let alone cover hospitals for emergencies.

Alternatively, the services of a company like AcuteCare Telemedicine can be obtained for a small fraction of the cost, and can cover a larger number of patients in many different regions of the country sequentially or even simultaneously. Telemedicine specialists would only be called when needed, and because many ACOs would be employing the group on a fractional basis, the cost to each one would be far lower than that of hiring even one neurologist full time. Furthermore, studies show that patient satisfaction and stroke outcomes are as high as in-person consultations in urgent care situations.s

Teleneurology and the development of ACOs will have a mutually beneficial relationship in the coming years. Practitioners of this field will find a welcome home in these organizations and will help solve the coming shortage of neurologists in a new era of medicine.



Physician Compensation Accounts for Only 8% of Total Health Care Costs

Physician compensation is commonly perceived as a factor in the rising cost of healthcare. According to a May 2011 report released by Jackson Healthcare, this is simply not the case. The report concluded that physician compensation accounts for only roughly 8% of the total annual healthcare costs in the U.S., and in fact, through telemedicine, doctors are able to provide a service which drastically reduces costs associated with physician clinical services.

From the report: “According to the most recent estimate from The Centers for Medicare and Medicaid Services (CMS), overall U.S. healthcare spending in 2009 was $2.5 trillion. CMS reports that physician clinical services account for $505 billion. Calculating the percentage using the most recent statistics on the number of practicing physicians in the U.S. from the American Medical Association and salary figures from MGMA, annual aggregate physician salaries total just 8.6 percent of total U.S. healthcare costs.”

AcuteCare Telemedicine, although founded by 4 practicing neurologists, is focused on improving patient access to quality care by lowering the costs for healthcare institutions.  The telemedicine services offer hospitals an affordable solution to providing 24×7 coverage to its patients relative to acute stroke care.

“As physicians, we dedicate our time to helping our patients,” comments Dr. Matthews Gwynn, CEO, AcuteCare Telemedicine.  “We may not be able to control rising healthcare costs, but we can identify cost effective solutions for healthcare providers that lower costs and improve patient care.”