Telemedicine Gains Ground, Finds Early Successes

By Jennifer Larson, contributor

June 25, 2013 - Telemedicine continues to gain traction across the country. The triple aims of healthcare reform--improved patient care, improved health of populations and cost containment--are all advanced by telemedicine. So are many of the new value-based clinical goals that will increasingly guide reimbursements and compensation, such as improved patient satisfaction and reduced readmissions. And telemedicine also supports the market forces pushing healthcare delivery to simultaneously provide greater efficiency and greater patient-care quality.

The American Telemedicine Association defines telemedicine as “the use of medical information exchanged from one site to another via electronic communications to improve patients' health status.”  This can include “videoconferencing, transmission of still images, e-health including patient portals, (and) remote monitoring of vital signs.” Nursing call centers are often involved in providing telehealth services, as well. And the possibilities seem to be growing.

Indicators of increasing support  

There are several recent examples of the advancement of telemedicine:

•• Funding allocated for telehealth resources: Earlier this year, the U.S. Department of Health and Human Services announced $1.9 million would be allocated for a new national telehealth resource center and several regional centers as part of the Telehealth Resource Center Grant Program. The centers will work to establish telemedicine programs for rural and medically underserved populations.

•• Guidelines embraced: The American Heart Association and the American Stroke Association issued a set of guidelines that endorsed the use of telemedicine, specifically in the development of regional networks of stroke centers, community hospitals and acute care hospitals that are “stroke-ready.”

•• Congress considers expansion: At the end of 2012, the Telehealth Promotion Act of 2012 was introduced in the U.S. House of Representatives.  Among other provisions in the bill, the legislation called for making changes to Medicaid and Medicare to augment and expand the use of telemedicine.

More states have laws in the works: A growing number of states are considering legislation to expand the use of telemedicine, as well. The American Telemedicine Association tracks such legislation in the states, and shows many have legislation pending.

“It’s double the action this year than it was last year,” said Jon Linkous, chief executive officer of the American Telemedicine Association. “Not all of them will adopt the legislation, but a number of them will.”

The most recent states to sign a telemedicine-related bill into law are Colorado, Nebraska and Nevada. A handful of other states enacted laws earlier this year--including Mississippi, which now allows insurance companies to reimburse doctors who consult for patients in rural areas using telehealth. And in Vermont, a new law is focused on a pilot program to study the effects of telemedicine when delivered outside of a healthcare facility.

A major driver in this growth of telemedicine at the state level may be health reform; as a result of the Affordable Care Act (ACA), states are anticipating an increase in the need for health care services, as millions of people are added to the insurance rolls.

•• Certification for nurses established: Another sign of success is professional recognition of telemedicine expertise. For example, in 2011, the American Association of Critical-Care Nurses (AACN) Certification Corporation launched the initial certification exam for the CCRN-E credential for critical care nurses who work in tele-ICUs.

Telemedicine limitations, successes and possibilities

Telemedicine isn’t necessarily the solution to every situation. For example, as Brendan Carr, MD, an assistant professor of emergency medicine, surgery and epidemiology at the University of Pennsylvania’s Perelman School of Medicine, noted, transplant surgery may not be the most likely venue for telemedicine in the near future.
“You can’t throw telemedicine at everything,” says hospital administrator and consultant Christina Thielst. “It has to be well thought out. But that’s the same with any technology: it has to match up, and there has to be a clear strategy.”

But telemedicine can make a significant difference in improving access to care and the care itself in many other situations. For example, one of the most noteworthy successes is in the arena of stroke treatment, or telestroke.

“It’s a very rapidly growing area,” said Linkous.

Carr and a team of researchers recently authored a study that showed how telestroke programs can improve access. They found that telestroke programs in Oregon were able to bring stroke care to less populated areas where people didn’t have access to stroke care within the 60 minute “golden hour.”  The 40 percent expansion was able to give more stroke patients the chance for a better outcome. 

Telestroke’s success could be applied to other arenas in which a telemedicine program can connect an expert with front-line staff in a community hospital or other setting to those who need the benefit of the expert’s knowledge; Carr used sepsis as just one example.

“Stroke is definitely the leader, but what I think is more exciting is that which is yet to come,” said Carr.

Telemedicine programs can also streamline the entire care delivery process in certain scenarios. Thielst pointed out that telehealth can connect mental health experts directly with their patients, who could consult with each other from the privacy of their own homes.

Telemedicine is also starting to really take off is in the consumer health arena, Linkous said. Consumers are beginning to demand easier access to primary care, which telehealth could address effectively.

The classic example is the parent who is reluctant to drag a child to the pediatrician’s office to sit in a waiting room full of sick children just to get a diagnosis of the sniffles. Some insurance companies are starting to reimburse for online consultations, Linkous said. Private insurer WellPoint began reimbursing physicians for virtual visits with patients in California and Ohio and plans to expand later this year. Linkous said he expects more to follow, as consumers clamor for this type of option and demand increases.

“It’s like a tidal wave that’s hit us,” he said.

Barriers still exist

Of courses, there are still some barriers to a more widespread integration of telemedicine. Proponents of telemedicine point to laws that prevent physicians and other providers from being able to practice across certain state lines as a significant barrier. The lack of consistent reimbursement is another perennial complaint.

Hopefully that will change as payers come to understand the long-term cost savings and benefits, Linkous said.

“Telestroke is a great example of where the cost reductions in the long term are really significant,” he said, explaining that early intervention can not only save lives, but also prevent the need for costly long-term care for people who have suffered debilitating strokes.

“You have a plethora of programs that are spilling out all over the country,” he continued. “The big problem is that they’re not fully reimbursed.” Despite the reimbursement issue, however, he pointed out that these programs are still being seen in increasing numbers. And they may continue to trend that way in the future.

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