AcuteCare Telemedicine Blog


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.



ACT Collaborates with Southeastern Medical Center on Telestroke Network

AcuteCare Telemedicine (ACT), the Southeast region’s largest practice based telemedicine provider, participated at Southeastern Alabama Medical Center’s (SAMC) press conference, announcing SAMC’s new stroke care network.

SAMC’s service area covers over 60 miles in each direction.  With technology in place, SAMC looked at possible resources to staff the new 24X7 model.  Neurologists on staff at SAMC are responsible for patients after admittance to the hospital, and often following acute symptoms or neurological events.  To be able to provide 24X7 coverage would be impossible. SAMC selected AcuteCare Telemedicine as its clinical service provider.

With this hub-spoke stroke care model, SAMC will be able to add hospitals to its network, expanding coverage across its communities.  Patients have already started to receive care, including tPA.  The initial results show improved patient outcomes.   The goal of the stroke care network is to educate communities on the importance of wellness, to identify signs before a stroke and generate awareness for the new services offerings SAMC can provide.

“Telemedicine is such a new technology for our population. We had concerns about patient adoption and comfort with being diagnosed remotely,” comments Ceclia Land, Division Director, Rehabilitation Services, SAMC.  “However, ACT integrated seamlessly into our processes, working alongside our team, to insure only the highest level of care to our patients. All of the doctors at ACT have an incredible bedside manner and are engaging.  They have become an integral part of our team.”

ACT will be on hand to diagnose and treat acute care patients. ACT offers cost-effective solutions that deliver complete on-call coverage, improve patient outcomes that adhere to HIPAA / HITECH requirements and establish a sustainable financial model for patient care.  The ACT Team of Neurological specialists are in the business of creating relationships that will serve as the foundation for improving healthcare for communities across the Southeast and Nationwide.

“SAMC has really established the new standard of care, expanding access to specialty care in underserved communities,” comments Dr. Gwynn, CEO, Partner, ACT.  “We look forward to our continued involvement with SAMC and its patients.  We have the potential to improve the statistics for residents across these communities in the hopes of saving lives lost due to stroke.  If diagnosed in time, we are able to administer tissue plasminogen activator (tPA) decreasing patient deficits after the stroke.”



Stroke Mimics in the Emergency Setting

The role of the neurologist in treatment of acute stroke often focuses on the decision to use clot busting medication (tissue plasminogen activator; tPA), recommending care setting (e.g. ICU vs routine admission) based on patient deficits and prognosis, and of course, patient education in the midst of this emotionally charged experience. However, an often overlooked mandate for the neurologist is the proper recognition of stroke itself. Dr. J. Stephen Huff, Associate Professor of Neurology at the University of Virginia, provides a clear and comprehensive review of what are termed stroke “mimics” – disorders which may appear to be a stroke, but are not.

Stroke, broadly defined, is any prolonged disruption of focal neurologic function due to decreased blood flow from blood clotting in a specific region of brain. If that disruption is transient or intermittent it is typically referred to as a transient ischemic attack (TIA). If brain function is disrupted by a cause other than a blood clot, treatment with tPA may not only lack benefit but expose the patient to unnecessary harm. Recognition of “stroke syndromes” that result from specific artery involvement is the bread and butter of neurology. The abrupt onset of aphasia (language deficit) and right sided weakness almost certainly indicates a patient has blocked their left middle cerebral artery. Blocking this same artery on the right results in the classic presentation of left sided weakness and “neglect,” an inability to recognize one’s own physical deficits. In either case, the immediate administration of tPA can be life-saving.

Other disorders may cause brain dysfunction unrelated to a blood clot. This is the case in approximately 13-20% of patients presenting with presumed stroke. If the duration of symptoms is unclear, this number may even be as high as 30%. The most common mimic is seizure. Excessive electrical and chemical brain activity may result in focal weakness (Todd’s paralysis) and other deficits. If the seizure was not witnessed (especially in patients with previous stroke as the cause of seizures), excluding an acute stroke can be difficult. Focal neurologic injury from brain tumor, inflammation (e.g. multiple sclerosis), or even peripheral nerve palsy may be mistaken for stroke.

Stroke can be mimicked without direct injury to the brain. The most common mimic in this category is a complex migraine in which visual disturbance, weakness, numbness and even aphasia can occur. Hypoglycemia or, less often, hyperglycemia (low and high blood sugar) can cause general symptoms of lethargy or coma, but focal brain dysfunction (particularly weakness) often occurs and can outlast normalization of blood glucose. Finally, 30% of patients presenting with psychiatric causes of physical illness (i.e. conversion disorder) exhibit neurologic deficits, typically weakness.

Determining the cause of a patient’s deficits can sometimes be accomplished in an emergency setting through the use of CT imaging and appropriate diagnostic tests. Often the results of serial examinations, detailed history and, increasingly, advances in MR imaging can eventually lead to the correct diagnosis. However, certain diagnoses, notably migraine and conversion, are diagnoses of exclusion, so repeated events and extensive negative testing may be required for confirmation.

Among patients presenting with neurologic deficits, emergency department physicians correctly identify stroke before applying diagnostic studies in about 75% of cases. This means as many as 1 in 4 cases are incorrectly diagnosed. It is the role of stroke experts, like those of AcuteCare Telemedicine, to quickly and accurately determine the likely cause of neurologic deficits, the risks and benefits of multiple treatment options and convey a plan of action simply yet fully to the patient and loved ones. It is a difficult but rewarding task.



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.



Privacy Issues Come to Light

Last month, the Veterans E-Health and Telemedicine Support (VETS) Act was introduced to Congress. The bill would “allow health professionals at the Department of Veterans Affairs (VA), as well as outside VA contractors, to practice telemedicine across state borders if they are qualified and practice within the scope of their authorized federal duties.” Unsurprisingly, the bill is casting a new light on issues of privacy and security in the growing telemedicine field.

Currently, different states have their own regulations around privacy rules that range from less to more severe than federal HIPAA laws. The VETS act has raised the question of what rules, state or federal, would apply in cases of doctor and patient being in different states and consulting via telemedicine.

Outside of the discussion on Capitol Hill, organizations like the American Telemedicine Association (ATA) have been working to override laws in those states inhibiting the growth of telemedicine across state lines. Most cases of doctors attempting to provide telemedicine services to other states serve to fill a need in areas where specialists like radiologists or neurologists are in short supply. Limiting the reach of these practitioners is manifestly detrimental to healthcare access. Doctors currently must obtain licensure in other states in order to provide telemedicine care to patients who reside outside their own state. The ATA approximates that only 20-25 percent of U.S. doctors have licenses in more than one state – national medical licensing is one proposed solution that would also cover the complications of the VETS bill.

Regardless of whether these issues of state vs. federal regulation are addressed sooner or later, more legal questions about the privacy of data in the practice of telemedicine are inevitably becoming part of the conversation. Everyone, not just regulators, but also practicing physicians and their patients must educate themselves about the potential for rubbing up against HIPAA as eHealth services continue to grow in popularity.



Healthcare Reform and the Impact on Telemedicine

The recent announcement of the Supreme Court’s 5-4 ruling in favor of upholding the Patient Protection and Affordable Care Act (PPACA) has prompted widespread speculation among citizens of the US about the future of healthcare.  Notwithstanding the politics associated with the decision, the ruling carries significant impact for citizens in terms of access to preventive care and insurance coverage.

Telemedicine providers are heavily impacted by the ruling as well. The American Telemedicine Association (ATA) believes that it will positively impact the development of telemedicine, mHealth, and other remote technologies, citing 4 main reasons; the announcement reduces hesitation to invest in telemedicine technologies, protects existing investments in telemedicine, bolster’s telemedicine’s role in many healthcare programs, and strengthens telemedicine’s fundamental value proposition.

As healthcare enters its next era, telemedicine offers a model for streamlining care coordination and improving patient outcomes. In the period of time between healthcare reform being codified into law and the Supreme Court ruling to uphold it, there had been a great deal of uncertainty surrounding the healthcare industry implementing major changes in practice, as it would cause complications should the law be overturned, but the affirmation clears up many of the primary legal and cost concerns, opening the door for telemedicine to address logistical and financial pain points for both providers and patients.

Ultimately, telemedicine fits snugly into the PPACA. For ACO’s needing to include services unavailable in their area, a remote presence physician will be drastically most cost-effective than hiring a full time local MD. Telemedicine also helps alleviate costs for underinsured or completely uninsured patients as well as alleviating strain on the healthcare system caused by unnecessary emergency visits through improvements in preventive care. The court’s decision, while sparking some controversy on other fronts, is the latest step forward in the rapid evolution of telemedicine as a powerful solution for a multitude of healthcare issues facing Americans.



Checking in From the 2012 ATA Conference

AcuteCare Telemedicine (ACT) Sales Executive Michael Woodcock attended the 2012 American Telehealth Association Conference, the world’s largest telemedicine, telehealth, and mHealth event in San Jose, California.

Greetings from San Jose!

The 2012 ATA Conference has been very impressive. This year’s conference has drawn a record number of attendees (4,500) and more than 175 vendor exhibits. The exposition features several booths with groundbreaking new products and services. Attendees have been encouraged to share news and notes and interact with the conference on social media platforms, which is demonstrative of the kind of technical innovation on display here.

In addition to the exhibitions, there have been a large number of interesting presentations and discussions on a wide variety of topics relating to telehealth and telemedicine. I have attended highly informative Industry Executive Panels on growth sectors in telemedicine, reimbursement issues facing the industry, and perspectives on the state of mobile applications and their compliance with HIPAA as they relate to telemedicine.

Some of the highlight sessions included Model Telemed Programs (a Georgia Partnership for Telehealth presentation from Paula Guy), a feature presentation on Telemedicine and its profitability, and a keynote address by Apple co-founder and tech advocate Steve Wozniak. There are too many presentation topics to list, but suffice it to say the conference is a comprehensive, in-depth look at all facets of the industry. It is exciting to see the growing influence of telemedicine as a potent solution to many pressing healthcare issues.

A link to the full conference program can be found here.