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.



Honoring Our Veterans With Telemedical Technology

As we honor our American Veterans this month, it is fitting to examine how Telemedicine, the exchange of medical information via electronic communications, has vastly changed the way deployed soldiers receive access to health care and how the new communication system promises to offer better access to care for veterans in the future as well.

When Dr. Ronald Poropatich first joined the military 30 years ago, the digital cameras and web cams required for the use of telemedicine barely existed. Yet, during his career as the deputy director of the Telemedicine and Advanced Technology Research Center in the United States Army, Poropatich helped revolutionize health care for soldiers by bringing telemedicine technology to army bases and field hospitals around the world including in Somalia, Iraq and Afghanistan.

Today, soldiers in Iraq or Afghanistan can get second opinions on tricky medical situations from doctors located halfway around the world and can receive diagnoses from medical specialists, even when none are stationed at their base.  Telemedicine has advanced greatly, allowing soldiers to email photos of electrocardiograms (EKGs) or skin rashes back to physicians back in the U.S., and receive feedback within hours.

This technology has allowed the military to spot medical conditions that would have otherwise been missed or quickly garner second opinions on cases that have the potential to warrant costly evacuations. Telemedicine has also provided a way to treat soldiers for conditions like post-traumatic stress disorder, or depression, while preserving their privacy.

The survival rate, if you can get to a combat support hospital level 3 facility in Afghanistan, is a fantastic 90 percent, but that means a lot of guys and gals are surviving horrific wounds once thought to be fatal.  So providing a telemedicine lifeline to veterans once they are back home is imperative in order for veterans to communicate with health care providers outside of in-office visits.  Accessing their care through the use of a cellphone or webcam, recovering soldiers will be more likely to stick with rehabilitation programs and outpatient treatment, ultimately ensuring better mental and physical health outcomes in the long term.

Perhaps the best way to honor our veterans is to provide them the best of medical care through the use of Telemedical Technology.



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.



VETS Act Expands Veterans Access to Care

A bi-partisan bill, introduced by Representatives Charles Rangel (D-NY) and Glenn Thompson (R-PA) and cosponsored by 21 Members of Congress, would permit U.S. Department of Veterans Affairs health professionals to treat veterans nationwide with a single state license. The bill, known as the VETS Act, builds on the unanimous congressional enactment of the 2011 STEP Act (Servicemembers’ Telemedicine and E-Health Portability Act,) which provides a similar provision for healthcare providers in the U.S. Department of Defense. A similar licensing rule for patients and providers of Medicare, Medicaid and other major federal health programs was included in a comprehensive telemedicine bill submitted by Rep. Mike Thompson (D-CA) in December 2012.

These bills are a simple way, while preserving the states’ role to license, to address shortages of medical specialists, to improve patient access to the best qualified physicians, and to accommodate mobile Americans and multi-state health plans,” said Jonathan Linkous, Chief Executive Officer of the American Telemedicine Association.  Currently, most providers who practice interstate telemedicine must be licensed both where the patient and provider are physically located. In some states, medical boards are even imposing stricter licensing requirements for telehealth providers than they do for in-person care, such as requiring a prior face-to-face examination for each and every case.

The Veterans Administration is consolidating many medical specialties in regional facilities that are often located a considerable distance from veteran patients who need regular treatments for injuries suffered in the defense of the country.  In some cases these patients need to travel into another state to receive specialized care, resulting in significant inconvenience and expense to VA beneficiaries.  The ability to treat these patients across state lines by use of telemedicine technology promises considerable benefits to patients and the VA care providers.

For the Veterans Administration who is currently experiencing a backlog of more than 500,000 requests for benefits, removing or lowering regulatory barriers will surely enhance the accessibility of care for patients living in areas remote from VA treatment centers while generating operational efficiencies for the VA.



Telemedicine, Bringing Improved Medical Care to India’s Rural Poor

In the United States, much has been said about how Telemedicine technologies are offering improved access and medical care to rural locations, particularly access to specialized medical care providers. But in many countries such as India, the opportunity to advance medical care to rural areas has a much more profound meaning to those in need of health care services.

India is administratively organized into state towns, district towns, block marketplaces, and then villages and healthcare, as such, is distributed along that supply chain with each level of infrastructure offering a lower standard of care.  Even in some of the fastest growing regions of India, as many as 85 percent of the 100 million residents only have access to healthcare that is at the bottom of the quality spectrum.  Private, better quality medical services may be located hundreds of miles away and take hours or days to reach by rural patients and are only available for those who have the money to pay.

Enter World Health Partners (WHP), an international nonprofit organization that provides health and reproductive health services in low-income countries by harnessing local market forces to work for the poor. Leveraging existing social and economic infrastructure, WHP utilizes the latest advances in communication, diagnostic and medical technology to build an ecosystem atop the existing private sector to bring improved medical services to even the most rural areas of India.

WHP is teaming up with out of the way, unlicensed, village health practitioners, or Quacks as they are known in India, to connect poor, rural patients with doctors located in Patna and Delhi.  For an investment of about $1000.00, each of the more than 433 quacks currently in WHP’s network of telemedicine practitioners can set up a Wifi network, laptop computer and the necessary equipment to make it all work, or at least work most of the time.  The system is not perfect and experiences frequent break downs but it saves time, money, and in some cases can save lives, for rural families that would otherwise have to travel hours to larger cities.

World Health Partners is working towards setting up 16,000, mostly privately owned and operated, telemedicine centers throughout India’s most rural provinces in hopes of bringing the convenience and benefits of telemedicine to the poorest of India’s population.  In addition, the concept is being scaled to be exported to countries and regions well beyond India, with hopes of reaching millions of world’s neediest populations.



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.



Opening the Dialogue to Better Care

Amidst much confusion and debate about plotting the best course towards achieving the so-called ‘triple-aim’ of increasing quality, improving patient satisfaction, and reducing costs, the healthcare community is struggling with communications amongst payers, vendors, and providers. Creating initiatives that encourage the development of more efficient, more sustainable healthcare requires the participation of all these entities in an ongoing conversation.

For physicians, making the ecosystem more intelligent is not exactly a simple proposition. Focused on delivering care, doctors typically do not have affinities for nor access to the kinds of information readily available to payers and vendors, such as performance metrics, analytics, and risk management considerations. Fostering an environment in which this data and knowledge can be openly shared is a pivotal step in helping doctors operate smarter.

As eHealth and the growth of telemedicine begin to significantly impact the delivery of care, the healthcare industry must address questions as to how physicians can better access these insights and be stimulated to embrace best practices, as well as how plan members can be similarly empowered to make better decisions. The answers come in the form of more open dialogue. Each party needs to share a similar, if not identical perspective on what constitutes quality to effectively collaborate.

With an ever-expanding arsenal of tools and knowledge at their disposal, physicians must call upon available resources in the form of industry partners to take advantage of this opportunity. The result will be a more intelligent system that benefits the entire network.