Expert: Third-Party Telemedicine Services Can Complicate Care Management

Nov. 21, 2014
Third-party telemedicine services are promising but may complicate the care management under new reimbursement models, says Ryan Spaulding, Ph.D., Director for the Center for Telehealth and Telemedicine at the University of Kansas Medical Center.

Ryan Spaulding, Ph.D. sees opportunities and challenges abound when it comes to tele-anything.

Whether its telemedicine, which he sees as generally a real-time consultative experience between providers or a provider and patient or telehealth, which he applies to a broader sphere of mobile health, Spaulding says both are ripe for incredible growth thanks to the overall change in reimbursement models.

The distinction between the two is important as Spaulding is director for the Center for Telehealth and Telemedicine at the University of Kansas Medical Center as well as its associate vice chancellor of community engagement. The center, created in 1991, advocates and offers services in both telehealth and telemedicine. It also advocates for telehealth and telemedicine use within the state, which has helped Kansas earn an A from the American Telemedicine Association (ATA) in terms of telemedicine physician practice standards and a B in telemedicine coverage.

Dr. Spaulding will be one of the featured speakers on Dec. 10-11 at the Institute for Health Technology Transformation’s (iHT2) Health IT Summit in Houston. He and two others will be on a panel titled, “mHealth & Telehealth: Reducing Readmissions through Innovative Care Models.” Click here to register for the Houston Health IT Summit to see Spaulding and others. (iHT2 is a sister organization with Healthcare Informatics under the corporate umbrella of the Vendome Group)

Spaulding recently spoke with Healthcare Informatics’ Senior Editor Gabriel Perna to preview that panel. They spoke on the future of telehealth and telemedicine, what it will take to achieve mainstream healthcare integration, and how companies like Google affect the tele landscape. Below are excerpts from that interview.

What opportunities do you see with telehealth when it comes to reducing readmissions?

We see and are working toward home monitoring and feel like there is a real opportunity there. The data so far has been mixed. You’ve probably seen the papers out there, which say there is clearly a benefit to home monitoring to reduce readmissions and other papers say there is no benefit. It boils down to yes, the technology can work but it requires some additional support around it to make it successful. It can’t just be technology monitoring. There have to be the appropriate protocols followed. There need to be best practices involved with having the physician on board, having caregivers on board, and having a coordinated effort. That could be some of the explanation with the data that’s been out so far.

That’s a real opportunity and that’s just data monitoring. We also think in-home, real-time consultations are an opportunity. We are doing some of that now with iPads. That’s more the telemedicine model. A lot of these concepts will blend together. Through mobile you’ll be able to do consultations and also collect data.

What will it take for telehealth to get fully integrated into mainstream healthcare and not just used as a niche?

I think readmissions will be one of the key drivers. Health reform has forced health systems to think a lot more on how technology can reduce utilization.  Also, with electronic health records (EHRs) being available and patient portals being available, health systems are figuring out what else can be done through EHRs. I know at our hospital there is an effort to capitalize the EHR and use it for more than just data storage and data management. It’s more of an outreach tool. That will drive this work too. And just the collaboration, health reform has forced us to think more about collaboration and the ACO model. All of those things are working together to mainstream some of this technology.

What do you make of companies like Google becoming involved with telemedicine?

It’s hard to see where that’s going to go. A lot of the patients who are served need to be connected to a health system somewhere. As you know, reimbursement, especially with Medicare and Medicaid, requires everyone have a primary care physician to help manage their care. When you bring in a third party like Google or another service, the care is moved outside the approved gatekeeper. I think there is a place for those services because a lot of people can’t get care. And to the extent those services can reduce access problems, then that would be helpful. If they can still report back to the primary care doctor with a consultation note/progress note to tie those providers together, then that would work. As standalone services though, it complicates managing care.

Can large tech companies, like Google, bring telehealth/telemedicine to the forefront?

I think so. One of the things we’ve been concerned about, even with all these new technologies and third-party telehealth services, there is still a digital divide. The extent to which Google can reduce the digital divide by its name and ubiquitous nature of being on any device or computer can hopefully reduce the divide at a low cost. I saw the Google article what they’re trying to do. I wasn’t sure if they put a price on that or yet.  

And it’s not just Google. There are a lot of companies that are coming up with these standalone telehealth services.

Part of the issue is still access. Most of those companies require a subscription or a payment at the time of service. It might help reduce some access issue for those that can still afford 40 bucks or subscription, but there is still a concern at the end of the day that access may not be changed a lot because a lot of people still can’t afford that. As you can tell, I work in the world of underserved and health disparities, and using telehealth to address those issues. I think that these third party services are good, but we have to keep access in mind and digital divide in mind.

Where do you see telehealth and telemedicine headed as demand rises?

What we hear the most is that [telehealth] will be a part of bundled payments or part of a DRG (diagnosis-related group), where , let’s say, congestive heart failure patients have telehealth as part of overall treatment and discharge and transition to home plan. All of that being included in payment will reduce chances for readmission but improve their health longer-term beyond just 30 days or 60 days.  What we believe is there is going to be, whether it’s called telehealth or something else, we’re at the point where the ongoing patient engagement will be the sweet spot for healthcare. It’s not episodic care, it’s a continuum of care. The extent to which telehealth supports that is where telehealth will go.

To learn more about telehealth and reducing readmissions please check out the Health IT Summit in Houston, December 10-11, 2014 sponsored by the Institute for Health Technology Transformation.

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