The why and how of telemedicine

April 11, 2015

Telemedicine is on the rise. Between 2012 and 2013, more than 10 million Americans benefited directly from it1. Its acceptance by patients and physicians is growing at a healthy pace. Google recently announced a new program that will enable users to chat with nurses online every time a medical condition is entered into the search bar.

Telemedicine encompasses a wide range of technologies, from in-home heart pressure monitoring to live video consultations. Our focus here is the potential for synchronous and asynchronous online communications between patients and clinicians: televisits, Web-based group meetings and pre-recorded video presentations.

What should an organization consider before taking the plunge into telemedicine?

The first question to ask is how telemedicine can support a provider’s strategic goals. In addition to improving healthcare outcomes, telemedicine can:

  • Reduce delivery costs: Medicare’s Health Buddy system provides patients with a home device that monitors and sends vital signs to clinicians, who then can send advice back to the patient. It has reduced per-patient costs by as much as 13 percent2. Telemedicine can also help improve margins. In-home monitoring can reduce hospital readmission rates and avoid the penalties Medicare imposes when readmissions are avoidable.
  • Improve the patient experience: Consumers are embracing telemedicine. A 2013 study conducted by Cisco found that 74 percent of patients would be comfortable communicating with doctors via technology3. With telemedicine, patients can connect more conveniently and quickly with medical professionals, especially with specialists who, for a variety of reasons, might be inaccessible.
  • Expand provider outreach: With telemedicine, healthcare organizations can increase revenues and brand awareness. Hospitals can partner locally with community providers to extend the reach of their clinical expertise. Healthcare organizations can also partner with organizations in other geographic regions. These partnerships can be a straightforward and attractive alternative to complex mergers and acquisitions.

In addition to understanding how telemedicine can further corporate objectives, healthcare leaders must understand the regulatory landscape. Regulations aren’t a major challenge for local providers using telemedicine with existing patients; however if the goal is to add patients or offer new services such as urgent care, regulations are more complicated and can vary widely from state to state. Providers must consider the following:

  • Telemedicine services can be offered separately in some states, or used in conjunction with a prior or subsequent in-person evaluation in other states.
  • In states that allow telemedicine reimbursement, payment usually is provided for office visits only. Coverage of other services can vary significantly from state to state.
  • Several states do not cover telemedicine services when a patient is at home. Often, patients must go to an approved facility or provider location for their care in order to be covered by insurance.
  • Many states restrict coverage for certain providers of telemedicine. For instance, a number of states do not allow reimbursement for telemedicine services offered by mental health professionals.
  • If the organization is planning to offer telemedicine services across state lines, clinicians typically must be licensed in the state where the patient is receiving treatment.
  • Medicare currently limits telemedicine reimbursement to people in remote locations or where access is otherwise restricted.

What are the biggest challenges in implementing telemedicine?

There are two big ones. The first is assuring that the technology meets patient needs and expectations. The second is securing clinician buy-in.

To make sure telemedicine meets the needs of patients, providers should look at their circle of care and analyze how well it translates to telemedicine. Visual and audio communications may work better with some interactions than others. For example, certain types of hospital discharge management, postoperative follow-up or behavioral therapy are conducive to telemedicine, while other interactions may not be as well suited. Organizations also must understand their patients’ comfort level with telemedicine and determine what can be done to ease any apprehension. Older patients are the largest part of the market and commonly prefer to see their doctors in person.

Securing the buy-in of clinicians requires a strong medical case. A business rationale, no matter how strong, won’t be enough for most caregivers. The medical case must be based on data and experiments. Doctors are pulled in many directions and can’t pursue every new development. Getting their support requires compelling evidence.

Getting clinicians on board can be helped by having clinical champions who will spread the word among their colleagues. And they needn’t be early adopters or even the most innovative physicians. In fact, younger tech-savvy doctors may not have been introduced to telemedicine during their training. In many cases, they still could be concentrating on building their clinical skills and practices, and they may not have the bandwidth to focus on telemedicine. At Massachusetts General Hospital, telemedicine’s champion turned out to be a veteran burn surgeon. He became an evangelist for telemedicine when he realized that some of his patients had to travel a full day for, say, a 15-minute consultation.

How has the reimbursement and financial landscape changed with the Affordable Care Act and value-based medicine?

There are two macro trends at work here. The first is reimbursement for additional services through traditional fee for service. Medicare and other payers increasingly are reimbursing telemedicine charges. This year, Medicare is broadening the scope of telemedicine services covered in rural areas. It also is removing restrictions on reimbursement under its accountable care organization (ACO) program. Medicaid and commercial payers are more likely to cover telemedicine than they have been in the past.

The second trend is the transition from fee-for-service to value-based contracts. As reimbursement criteria shift from quantity to quality, telemedicine can lower costs, allowing healthcare organizations to reach more patients with a better level of care. A partnership between Southwest Georgia Health District’s Centering Pregnancy program and Atlanta’s Women’s Telehealth is a case in point. The partnership significantly reduced pre-term births among Hispanic and African-American women in an underserved section of Georgia. In a pilot program, physicians participated online in on-site patient group meetings. The doctors also were available online for specific patient interventions. The results were notable: Among African-American women, the incidence of pre-term births (with their attendant costs in money and resources) was 8.1 percent compared with the baseline rate of 18.2 percent in the region4.

Telemedicine can reduce the costs of provider-to-provider interactions as well. A study by the Center for Technology Leadership found that the expected savings from cutting the number of physical transfers between emergency departments through telemedicine easily would cover the costs of equipping all U.S. emergency rooms with the capability. Similarly, the cost to outfit a nursing home with telemedicine technology would be more than offset by reducing the costs of sending patients to an emergency room or a doctor’s office for issues that could be handled remotely5.

With hacked systems almost a daily headline, how can we protect data and assure privacy with telemedicine?

Digital transmissions and stored data must be protected with the latest encryption technology standards, such as those used with online banking. Even with the best security, consumers still may be wary of connecting from home. To assuage those concerns, the Cleveland Clinic and HealthSpot offer kiosks in convenient locations where patients can use a small room to connect virtually with their physicians. More than 90 percent of patients were satisfied with the kiosk experience.

Healthcare providers must educate patients on information security just as online commerce companies educate their customers. Organizations need to drive home the importance of safeguards: Don’t provide sensitive information in any transaction you haven’t initiated, and don’t use telemedicine services on any device that is not solely yours.

As is the case with many new technologies, telemedicine’s adoption will be incremental. But it also will be transformative. When smartphones first appeared, they were an expensive novelty, and many questioned whether consumers needed or wanted computers in their pockets. And when Amazon first began selling books online, few imagined consumers buying everything from appliances to tuxedos on websites. Telemedicine will follow a similar path as cost pressures and consumer demand continue to build.

References

1. http://www.businessweek.com/articles/2014-02-27/health-insurers-add-telemedicine-services-to-cut-costs

2. http://www.americantelemed.org/docs/default-source/policy/examples-of-research-outcomes—telemedicine’s-impact-on-healthcare-cost-and-quality.pdf

3. http://newsroom.cisco.com/release/1148539/Cisco-Study-Reveals-74-Percent-of-Consumers-Open-to-Virtual-Doctor-Visit

4. http://www.americantelemed.org/about-telemedicine/telemedicine-case-studies/case-study-full-page/georgia-partnership-uses-telemedicine-and-centering-pregnancy-model-to-significantly-decrease-preterm-labor-birth-rate-in-high-risk-areas#.VFwB1bstDIV

5. Ibid.

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