Telemedicine: Poised for Tipping Point

Several things are happening that will influence telemedicine in 2013; there is going to be a tipping point.

Telemedicine¹ via secure electronic communications will become a standard tool for care delivery wherever appropriate. It can be used like a phone or fax until the healthcare information (EMR/EHR) market matures. Video consultation without exchange of personal health information (PHI) does not fall under HIPAA guidelines.

Here is an overview of disruptive trends:

 

TELEMEDICINE REIMBURSEMENT

Reimbursement has been an on-going barrier to telemedicine growth; this is changing. Recently thirteen states, plus the District of Columbia, have introduced legislation that would further expand both usage and reimbursement of telemedicine services.

Statewide activity continues to be tracked. The Center for Connected Health (a non-profit, non-partisan policy research, planning and technical support organization) recently released a comprehensive update on the “State Telehealth Law and Reimbursement Policies – February 2013.”  New uses of telemedicine are being identified and reimbursement addressed.

 

INABILITY TO CROSS STATE LINES

Physician license portability is another barrier that is slowly changing. The VA, a silent leader in healthcare reform, has already enabled healthcare providers to cross state lines to care for our veterans.

Nationally, Sen. Tom Udall (D-NM) announced (in February 2012) his intent to introduce a bill in the spring to expand telemedicine and medical license portability; that did not materialize. In December Rep. Mike Thompson proposed H.R. 6719, which would establish a federal reimbursement policy and provide a new federal standard for medical licensure; it is still in committee,

On a state level, Massachusetts State Representative Dan Winslow proffered bill in June to allow doctors licensed anywhere in the United States to consult, diagnose and treat Massachusetts residents by internet video examinations.

Any of these bills would have been first steps to removing medical license portability barriers and to legislated reimbursement on a national level; all bills seem to have died in committee… still, these are all precursors to change.

While some concern may be merited, issues can be addressed. State line barriers will eventually be removed; telemedicine needs nationwide or federal licensure, state reciprocity, mutual recognition, and registration. Resistance is territorial and monetary-based… unmanageable growth, loss of control… and vested interests. Patient safety issues and Medicare fraud/abuse already exist; neither the public nor state oversight (medical boards) will tolerate those who exploit patients or payor systems.

 

INTEROPERABILITY

Lack of interoperability across health data silos is a major barrier in moving adoption of telemedicine and telehealth forward. Lack of interoperability will be the focus of 2013; Healthcare Information Exchange participation requires it.

Health IT systems vendors McKesson and Cerner are reported to be working on a deal to cooperate on health information exchange (HIE)… “potentially breaking down a key barrier to the vision of a nationwide network of interoperable electronic health records (EHRs).”

“It also would put the two companies on stronger footing against rival Epic Systems, which has come to dominate other enterprise EHR vendors in the fast-growing ambulatory market.” EPIC’s CEO has been reported as having no interest in interoperability; watch for a change of heart.

 

PHYSICIAN UNDER DURESS 

Physician frustration is mounting; they are overwhelmed by changing federal mandates, compliance and reporting regulations, changing reimbursement (ICD codes) and changing payor structures (ACOs)… and growing technology demands.

Physicians have invested in EMR software only to find they need to upgrade or change vendors, or there is no flexibility to accommodate work flow. The cost to physician practices is not just the cost of software; administrative and management demands are stealing time away from patients.

The lack of interoperability between physicians, hospitals, insurance companies, and health information exchanges raise additional concern. Even with huge investments, many physicians won’t qualify for federal funds under “meaningful use.”

Some physicians are opting out of Medicare altogether; concierge medicine is growing (25% increase in 2012). Many physicians are moving out of private practice, and while “physician need analyses” debate physician shortages, access to physicians is changing. Patients are finding their physicians have retired, moved on to larger practices or hospitals… or taken other roles in healthcare.

 

NEED IS SELF EVIDENT  

The need for telemedicine across state lines is evident. When the VA removed state barriers for veterans needing mental healthcare services, they were responding to a stark reality. In 2010 veteran suicide rates were reported to be an average of 18 per day; that is one every 80 minutes. Recent shootings by the mentally ill underscore the need for “expeditious” mental health care access everywhere.

But the VA did not stop there; it expanded telemedicine healthcare access across state lines. Studies show that telemedicine can be an effective way to connect patients to providers regardless of where either is located.

 

WRITING ON THE WALL

News articles of life saving consults and rural telemedicine efforts are showing up all over the Internet; telemedicine has proven an effective tool in many areas. Certainly telemedicine is not a panacea for healthcare but the need for every viable tool is apparent. The United States is a mobile population; healthcare access should be just as mobile. Telemedicine should not be limited to rural areas.

Telemedicine will be a stand-alone tool used by physicians and professional health care providers. It need not interface with any electronic health record but it needs to have ID authentication (provider and patient) and secure data/image sharing, storage, and retrieval functions.

Telemedicine will be widely used by employers as a healthcare benefit to reduce the growing cost of healthcare benefits. Insurance companies will recognize the savings and promote reimbursement; some already are.

Telemedicine is poised for a tipping point; it will become a standard tool just like phone or fax. Innovation is already taking place but not all innovation happening today can be found on the Internet.

True disruptive innovation usually happens at a grassroots level. The shift toward telemedicine use and public acceptance is clear. With mounting cost of healthcare benefits, the public will request it; perhaps via employers and employees feeling the increasing burden of healthcare costs… but the handwriting is on the wall.

 

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For the purposes of this article sources were provided within content for easy reference (excuse the lack of APA format)

¹ – “Telemedicine” is defined [CMS] as “provision of clinical services to patients by physicians and practitioners from a distance via electronic communications.”

http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/SurveyCertificationGenInfo/downloads/SCLetter11_32.pdf

² – “Telehealth” is defined as “the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration.”

http://www.hrsa.gov/ruralhealth/about/telehealth/

 

 

4 thoughts on “Telemedicine: Poised for Tipping Point

  1. Very nice write up Sande! I am the CEO of vsee.com, a skype alternative that is as simple and consumer friendly as skype, but FDA registered and HIPAA compliant. I would add one more traditional barrier to telehealth – the cost and complexity of telehealth systems. the days of iPhone and iPad nearly-free telehealth apps are here! 🙂

  2. Agrees with Sande in toto… telemedicine / telehealth will hit the roof 2013 once inter-state telemedicine issues are resolve; but there is still an enormous global market out there for US doctors across borders. See http://www.u2Doc.com as one such that may support teleconsultation possibilities for US doctors worldwide. Cheers.

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