Survey: Telehealth Increases Access to Care, Continuity

Michael Laff Minneapolis – November 11, 2015 04:12 pm

Your patients depend on you for the best medical care, and thanks to technology, they don’t necessarily need to visit your office to receive it.

As more family physicians begin using telehealth systems, speakers at the AAFP State Legislative Conference, held here Nov. 6-7, discussed how the technology can enhance patient care and sharedfindings from a survey(www.graham-center.org)(22 page PDF) of family physicians’ thoughts about and use of telehealth.

Researchers at the Robert Graham Center for Policy Studies in Family Medicine and Primary Care said 15 percent of the 1,557 physicians who responded to the survey reported using telehealth in the past year. The survey contains some bias because respondents were more likely to use telemedicine, explained Megan Coffman, M.S., a health policy administrator for the Robert Graham Center who presented the research.

Respondents said the technology’s strongest points are improving access to care and providing continuity of care. Obstacles they cited included the cost of equipment, lack of training and potential liability.

A profile of the typical telehealth user emerged as one who:

  • is more likely to be practicing in a rural area (76 percent),
  • works with six or more family physicians (40 percent) and
  • uses electronic health records (98 percent).

When physicians were asked how they used telehealth, the leading responses were diagnosis or treatment (55 percent), chronic disease management (26 percent) and patient followup (21 percent). Physicians, whether they use telehealth or not, agreed that the technology improves access to and continuity of care. The question of whether it reduces cost has not been answered.

“There is not enough data on whether telemedicine saves money,” said Coffman. “That is yet to be seen. From a patient perspective, it saves time and money, but there is not enough information.”

Telehealth systems are good for increasing efficiency, said William Thornbury, M.D., R.Ph., the founder of an online appointment site called meVisit.(www.mevisit.com)

“We take 60 patents per day at the clinic,” said Thornbury, who also serves as medical director at the Medical Associate Clinic in Glasgow, Ky. “I can’t take any new patients. The real problem is 30 percent of my patients don’t need to be in the clinic, but the only way to get paid is to see them there. ”

meVisit’s telehealth application, available on mobile phones and computers, is designed to allow physicians to address minor health problems that do not require an office visit. Patients can select a reason for a consult from a menu or type it in themselves, and they can upload photos.

Thornbury said family physicians should consider telemedicine because retail health clinics are doing so. Walgreens plans to launch a telehealth mobile application in 25 states starting in January 2016.

“How is our health system going to compete in this arena?” Thornbury asked.

Thornbury said most patients pay a $37 copay for telemedicine visits. One of the concerns among insurers is that ease of access could lead to frequent, unnecessary consults, but Thornbury suggested that copays could be raised to solve that problem, should it arise.

States are beginning to recognize the value of telemedicine and are requiring insurers to do the same. Montana, for instance, passed a law requiring insurers to pay for telemedicine on terms equal to those for office visits.

As the medical profession moves to greater efficiency with an emphasis on reducing costs, Thornbury said family physicians should press hard for fair payment.

“Radiologists are benefiting from new technology that allows them to work faster, and they are not being asked to take less money,” he said. “Why are we being penalized for it? If we are more efficient and take on more liability, care is care is care.”

Related AAFP News Coverage
Gauging the Promise and Perils of Telemedicine
AAFP Calls for Adequate Payment, Fewer Restrictions

(6/24/2014)

Robert Graham Center Forum
Telemedicine Can Build Bridge to Expanded Health Care, Say Panelists

(2/5/2014)

More From AAFP
Member Interest Group: Telehealth

Family Practice Management: Should You Treat Your Patients Virtually?

Link to original article on AAFP

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Walgreens’ Telehealth Grows As We Warm To Digital Doctors

By: , November 12, 2015, 2:48 PM

It has also updated and improved the app, which provides round-the-clock access to MDLive’s network of U.S. board-certified doctors.

“Walgreens app-based approach is different than CVS’ in-store telehealth offering, and we’re still waiting to see what Walmart will do when it begins to roll out its option, but it’s clear telemedicine is gaining rapid acceptance,” says Jonathan Linkous, CEO of American Telemedicine Association, based in Washington, D.C. “We’ve seen more growth in the last two years than we have in the previous 20.”

Two years ago, he says, consumers had 800,000 tele-consultations with doctors, and that’s increased to 1.2 million this year. The biggest use is for urgent-care consultations with primary-care doctors, followed by mental health. And he expects a growth rate of at least 20% to 25% next year. “That’s pretty rapid, but it’s still only a drop in the bucket compared to its potential.”

“We have seen that telehealth solutions play an important role in helping to improve patient outcomes,” says Adam Pellegrini, Walgreens VP of digital health, in its release, “and we will continue to work to evolve our offerings to ensure our patients can choose what’s most convenient for them, whether that’s live doctor consultations, digitally chatting with a pharmacist or visiting a Healthcare Clinic.”

At its Minute Clinics, CVS uses telehealth to help handle patient overflow during busy times, giving customers the option of stepping into a private room for a tele-consult rather than waiting. In a recent study, it found that 95% of patients said they were highly satisfied with the quality of care and ease of use. One-third even said they preferred a telehealth visit to having a clinician in the same room.

For consumers, telehealth offers convenience and often a much lower cost than an in-office or even in-clinic visit. But Linkous says telehealth is also gaining traction because so many doctors and providers, who have been required to build elaborate patient portals, would like to offer it on their own platforms.

In a sign that Americans are cozying up to the idea of seeing a doctor via smartphone, Walgreens says it is expanding its partnership with MDLive to an additional 20 states. The retailer, which began testing the service back in December in California and Michigan, expanded to five states in June.

Link to original article in Media Post

Bipartisan Senate bill aims to waive telemedicine restrictions for VA docs

A Senate committee heard testimony Wednesday on a bipartisan bill meant to ease telemedicine licensing requirements and facilitate mental health e-visits for Veterans Affairs healthcare professionals.

Current rules call for physicians using telemedicine to be licensed in the state where the patient resides.

According to bill sponsor Sen. Joni Ernst (R-Iowa), state licensure requirements are waived for the VA if both patient and doctor are in a federal facility during the e-visit. Home e-visits are allowed only if the two parties are in the same state. Ernst’s “Veterans E-Health and Telemedicine Support Act of 2015” would allow home e-visits regardless of where the VA clinician is located or licensed. This would apply to both VA-employed physicians and those under contract to deliver care outside of VA facilities.

“That’s a very important issue,” said Dr. Maureen McCarthy, acting VA assistant deputy under secretary for health for patient care services. She added that, under current practice, providers under a national service contract could find it necessary to get licensed in all 50 states.

Some 677,000 veterans received telemedicine services last year including 122,000 who received mental health e-visits in their homes, McCarthy said. She added that this has led to decreased hospital admissions, lower travel costs and fewer missed appointments.

“Telehealth care is an innovative and important means to meet the wide-ranging needs of veterans in Iowa and nationwide, including the invisible struggles of mental healthcare,” Ernst said in a news release.

The bill is sponsored by lawmakers from mostly rural states. It’s main co-sponsor is Sen. Mazie Hirono (D-Hawaii), who says the issue of access is of particular concern to residents of her state.

“Hawaii residents often are forced to drive for hours to see their physician or spend thousands of dollars to fly to Oahu and the mainland to seek care from a specialist,” Hirono said in a news release. “The TELE-MED Act will help to eliminate the financial and physical stress of seeking quality medical care by allowing seniors access to Medicare-participating physicians from the convenience of their home or local doctor’s office.”

The bill had 11 other co-sponsors before the hearing. This was increased during the hearing when the panel’s ranking Democrat, Sen. Richard Blumenthal of Connecticut, added his name to the roster.

Committee Chairman Johnny Isakson (R-Ga.) praised the bill.

“Legislation like this is a godsend, I suspect, and helps us solve a significant problem,” Isakson said.

Along with easing licensing restrictions, the bill calls for assessing patient satisfaction with the service, provider satisfaction, frequency of use, wait times and the effect on access to care.

Though McCarthy said the VA is “thrilled” with the bill, it had some concerns about creating additional reporting requirements – such as provider satisfaction. She added, however, that for the most part, the concerns were over “minor details” that could be resolved.

The bill has been endorsed by the Veterans of Foreign Wars, Paralyzed Veterans of America, the American Legion, Concerned Veterans for America and the American Telemedicine Association.

The Federation of State Medical Boards adheres to the principle that the practice of medicine occurs in the state where the patient is located, which it says ensures oversight and accountability if a patient is harmed.

“In its current form, the proposed VA legislation falls short of ensuring these protections, and it should be amended to strengthen them,” said FSMB Chief Advocacy Officer Lisa Robin.

To facilitate telemedicine access to patients in rural or remote areas, the FSMB advocates states join the Interstate Medical Licensure Compact that was created to streamline the licensing process for doctors practicing in multiple states. So far, 11 states are participating in the compact and legislation to do so has been introduced in nine more, Robin said.

US Behind the World in Telemedicine

September 17, 2015 •

“The recommendations balance the potential benefits and expanded use of telemedicine with the importance of maintaining the patient-physician relationship and patient safety,” Hilary Daniel from American College of Physicians, Washington, DC, said by email.

Read the entire article HERE

Top Health Trend For 2014: Telehealth To Grow Over 50%. What Role For Regulation?

For many years, telehealth advocates have accused payers of being unwilling to reimburse for proven telehealth interventions, which can significantly reduce medical costs.

Well, we have crossed that chasm, and telehealth is about to experience explosive growth. RNCOS Business Consultancy Services has just released a report predicting 18.5 percent annual growth in telehealth worldwide through 2018. The U.S. will outpace the rest of the world. Forbes contributor Bruce Japsen recently interviewed an  analyst at another market research firm, IHS, who predicts that the U.S. telehealth market will grow to $1.9 billion in 2018 from $240 million today, an annual growth rate of 56 percent. This is explosive, and it has led to increased political activity.

Given the risk of unintended consequences of legislation and regulation, it’s a good time to have a look at how the major players are shaping policy.

According to Mr. Japsen’s interview with Roeen Roashan of IHS, much of the dramatic growth in U.S. telehealth will be driven by Accountable Care Organizations (ACOs), in both Medicare and among the privately insured. Although there are different models of ACO, all move beyond the traditional Fee-For-Service (FFS) payment system by implementing incentives to reduce costs while increasing quality. For example, if a physician in an ACO meets certain quality indicators that evidence suggests will reduce the risk of a patient being hospitalized, she will be rewarded by the ACO. In the old (but still dominant) payment model, her income would not have suffered for failing to meet these quality indicators. ACOs are found all over the country, with different levels of penetration, according to research by Leavitt Partners.

The jury is still out on whether ACOs will succeed. My own expectation is that early experience will not result in a “general theory” of ACOs, just like the previous experience of managed-care, which ramped up in the 1970s and peaked in the late 1990s, did not lead to a “general theory” of HMOs. A few worked and many did not, with leadership and commitment by all interested parties being critical to success. The ACO experience will likely be similar. Nevertheless, new technology has the potential to increase the likelihood of success. For example, remote monitoring of diabetic patients’ blood glucose from home can trigger an early intervention – maybe a phone call from a nurse on the care-team – that reduces the risk of hospitalization.

Traditionally, Medicare pays FFS via fee schedules. A certain code is attached to a certain procedure (the result of a cumbersome and confusing process) and this allows claims to be reimbursed. Medicare covers certain telehealth services, especially in remote rural areas. However, one of the most important telehealth services, sending a digital image to be stored at another site and read by a specialist (i.e. without the patient and physician speaking with each other over the phone), is not generally covered. Medicare coverage of telehealth tends towards mental health and behavioral interventions.

Previously, telehealth advocates have lobbied for Medicare to cover more telehealth services by adjusting the billing codes. However, in an interview last August with MobiHealthNews, Charles Linkaus of the American Telemedicine Association, which advocates for the telehealth industry, said that the ATA is “de-emphasizing its longtime efforts to secure reimbursement for telehealth technology” in favor of “a model where hospitals can also share in the savings when they successfully reduce re-admissions.” . This change is a positive development. Providers’ resistance to this kind of reform has always been problematic.

Although every provider of a medical service claims to reduce costs somewhere else in the system, they tend to shun payment reform that actually takes them at their word. Instead, they fall back on simply demanding increases to reimbursement for billing codes, and adding new codes for new products and procedures. This forces costs into silos and makes it difficult to incentivize cutting overall costs – or even to understand the relationship between different cost drivers. If the ATA is moving away from this model and actually lobbying for reimbursement that reduces total health costs while increasing quality, it is a move in the right direction.

Hopefully, the ATA will also take this approach in its advocacy for coverage by private insurance. According to a 2013 background document from the ATA, twenty states plus the District of Columbia mandate that private insurers cover telehealth. This means that if a benefit can be delivered either in person or via telehealth, it must be covered. Medicaid coverage is all over the map: As with Medicare, Medicaid coverage of mental telehealth is most common. Convincing state legislators to force private insurers or Medicaid to cover telehealth is one way to guarantee revenue to the industry, but it is inferior to a system where the incentives line up so that providers adopt telehealth on their own, to reduce costs and increase quality.

In 2013, two bipartisan bills were introduced in Congress, designed to encourage telehealth, and pushed by the Health IT Now Coalition, a group that has a broader membership than the ATA:

  • HR 3077, the TELE-MED Act, would permit certain Medicare providers licensed in a state to provide telehealth services to Medicare beneficiaries in a different state.
  • HR 3750, the Telehealth Modernization Act, would promote the provision of telehealth by establishing a federal standard for telehealth, and inducing all states to adhere to it.

Neither bill imposes a huge burden of federal control. Obviously, any service that uses telephony invites some federal role. However, the Health IT Now Coalition is careful to point out that these bills do not interfere with state sovereignty over the licensing of medical and allied health professionals. This has long been an obstacle to telehealth. Traditional licensing laws did not envision a physician in one state treating a patient in another state. While telehealth advocates have long lobbied for inter-state licensing of physicians and other health professionals, this is still a point of friction, which hinders rapid adoption.

Nevertheless, citizens wishing to preserve the constitutional order should be concerned about too much Congressional initiative in this area. A law that would allow Medicare providers to treat out-of-state patients via telehealth (HR 3077), notwithstanding state laws, certainly looks like it interferes with state’s power over professional licensing.

There is another approach, which achieves the same goal without Congressional overreach: The Federation of State Medical Boards has promised that it is very close to agreeing on language for aninterstate compact for physician licensing, which has already been achieved for nurses. A compact is a constitutionally approved method for states to make treaty-like commitments to each other. It is a very appropriate tool to accommodate mutual recognition of professional licensing for the purpose of inter-state telehealth.

It is especially important for states to maintain the initiative in this matter, because failing to do so will cause advocates to invest in lobbying for federal control. Congressional overreach would have unintended consequences that are properly dealt with by state law. For example, states have sovereignty over medical-malpractice laws and which health professionals have the power to prescribe drugs (as analyzed by the Robert J. Waters Center for Telehealth & eHealth Law). Responsible development of telehealth incorporates these and many other factors, requiring constant readjustment of regulatory priorities. Decentralized control at the state level ensures less likelihood of an inflexible and quickly dated regulatory regime, which often happens when Congress takes the lead.

Nevertheless, as we enter a year where telehealth is likely to change much of what happens in U.S. health care, we should be optimistic that both advocates and politicians are endorsing an approach that will allow providers, patients, and entrepreneurs to develop and adopt telehealth with minimal political interference.

If only we could say that about the rest of the system.

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Investors’ note: Corporations belonging to the Health IT Now Coalition include include Aetna (NYSE:AET),  AmeriSoure Bergen (NYSE:ABC), Boeing (NYSE:BA), Intel (NASDAQ:INTC), UnitedHealth Group (NYSE:UNH), Verizon (NYSE:VZ), WellPoint (NYSE:WLP), and WebMD (NASDAQ:WBMD).