Guide: Telemedicine benefits held back by lack of reimbursements
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The ATA Annual International Meeting & Trade Show of the American Telemedicine Association will host an estimated 6,000 providers, payers and other healthcare leaders May 5-7 in Austin, Texas. In this two-part interview, ATA President-Elect Ed Brown, M.D., founder and CEO of the Ontario Telemedicine Network, sat down with SearchHealthIT to preview what attendees can expect from this year's meeting and to discuss how telemedicine potentially can play a part in accountable care organizations' reshaping of U.S. healthcare, as well as other telemedicine benefits for improving care. See our ATA 2013 conference guide for more meeting coverage. View part two of the interview here.
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What's the current overall state of telemedicine or telehealth? And what's the difference?
Ed Brown: That's a hard question. You'll get a lot of different definitions depending on who you speak to, but I don't think there's any difference, really. I just use the words interchangeably.
I think we're at a very exciting place for telehealth. The field has been around for about 50 years now, and it's moving along slowly, but you can see in the last number of years it's accelerated dramatically. Those of us in the field are pretty excited that we're reaching a point of becoming a mainstream part of the healthcare system.
What are the biggest telemedicine and mHealth topics that will be discussed at this year's meeting?
Brown: I think you're going to see the gamut. You're going to see pretty much every technology that's out there: from video conferencing to new wireless technologies to remote monitoring. You're also going to see a lot of solutions -- organizations that have bundled things together in ways that are being used across the healthcare system.
I think you're also going to see a lot of providers -- both organizations and individuals -- that have developed programs that leverage telemedicine solutions in virtual healthcare. You're going to see the payers who are interested in how to best insure services and pay for telemedicine and incorporate it into federal and state legislation.
You're going to see a global contingent, because ATA has visitors from all over the world [who] will bring an international flavor to the meeting.
What hot new telemedicine technologies should ATA attendees be excited about?
Brown: It's kind of like popcorn right now -- there's a new one every second. What's gotten a lot of interest in the last year or two are new wireless technologies, remote sensing technologies. But I can tell you, we're always surprised at the ATA meeting. There's always something new and different that arrives.
Since last year's meeting, what progress has been made in implementing telemedicine practices in both the U.S. and Canada?
Brown: I think what we're seeing right now is a bit of a sea change in the approach to telemedicine. There have been a lot of pilot programs, a lot of experimentation with where telemedicine fits into the healthcare system, and I think what you're seeing now is that people are actually incorporating it into their major initiatives and plans.
Right now there's a huge move afoot to transform the healthcare system. We're living longer, but we're living longer with chronic diseases. And we need a way to be able to support patients and manage patients, but still be able to afford that.
I think people are discovering that telemedicine and virtual healthcare technologies are part of that mix that will enable us to sustain the healthcare system. So, you're seeing telemedicine being incorporated into things like the accountable care organization; people are using it to improve their performance around the Medicare 30-day readmission penalties; certainly it's part of the medical home, and on and on. Many of the mainstream programs have now recognized that telemedicine should be part of their major services.
According to the ATA, approximately 200 telemedicine networks have been established in the U.S. and more than 50% of U.S. hospitals use at least one telemedicine service. As telemedicine practices continue to grow and evolve, what new opportunities for use -- or perhaps unforeseen problems -- are emerging?
I think what we're seeing right now is a bit of a sea change in the approach to telemedicine. … Many of the mainstream programs have now recognized that telemedicine should be part of their major services.
Ed Brown, M.D.,
founder and CEO, Ontario Telemedicine Network
Brown: There's been an explosion of different business models. Traditional telemedicine started out generally with academic centers that reached out to rural hospitals and delivered video conferencing services. That's still very much an important part of telemedicine. But since then, there's been a whole lot of other activities and technologies that are really part of the family of telemedicine. That includes things like tele-homecare, which provides things like remote monitoring into patients' homes; e-consult, which is what we call 'store-forward' telemedicine; new wireless technologies; texting -- there's really a broad range of new pieces to the puzzle that have been introduced over all those years.
In addition, there are a lot of very exciting business approaches. There are now companies that, for example, provide telestroke specialists almost nationwide. So, if your particular community doesn't have a telestroke specialist, they can actually beam one in and support you from anywhere. There are also people who are providing Internet-based physician services, so you can go online and see a physician from wherever you happen to be, using your PC and the Internet.
What's the biggest challenge facing widespread telemedicine implementation in the U.S.?
Brown: I can tell you that I don't think technology is the barrier. I think the challenge is developing business models that work. Consumers are not a barrier. For the most part, whenever they experience telemedicine services, they essentially love them. So, the real challenge is working these systems into the healthcare system.
Barriers can be a variety of things -- sometimes they're policy issues, reimbursement issues; and sometimes they're simply awareness issues. As those barriers start to fall -- and they are, they're falling as fast as dominoes right now -- we will certainly see increased uptake.
Some telemedicine service providers say their credentialing department is the busiest in the company, working to fill out paperwork and keep licenses valid in order to avail practitioners across state lines. Why is credentialing specialists nationally such a logistical nightmare, and how -- if at all -- do you see the process changing in the future?
Brown: One of the big challenges in the U.S. is the issue of requiring a license within the state that a patient is located. That's still pretty much the case in most states, and I think that is a huge barrier that needs to be addressed. Until that's addressed, there will be a big challenge spreading telehealth services across the U.S.
There are a lot of discussions being had right now, and ATA is at the table advocating for an approach that would enable appropriate cross-state telemedicine services. There are a lot of players around the table. I think that there is progress and I hope we'll see a lot more this coming year.
Reimbursement historically has been hard to come by for most telemedicine providers. Why is this, and how do you see it changing in the future?
Brown: It's changing right now. Reimbursement has been a challenge because traditionally, insurers have not paid for telemedicine services. Medicare, for example, does pay for telemedicine to census metropolitan areas that are considered rural. Now there are actually 19 states that have passed legislation that requires, for the most part, insurers to pay for telemedicine much as they would pay for face-to-face consultation. That's pretty good -- that's about 40% of states already on board.
What can healthcare providers to do work toward changing commercial and public payers' views that inhibit the growth of telemedicine?
Brown: They can work with us at ATA. A huge part of our activity is to work on public policy. We've got some great leaders that spend a lot of time working with legislators, working with policymakers to try to get the right bills, the right principles out there. We certainly welcome anyone with an interest in that area to talk to us and work with us.
Can telemedicine services help bring some relief to the widespread shortage of primary care physicians and even nurses?
Brown: Oh, I think it can. Really, what telemedicine enables you to do is to use resources more efficiently. It's a way for teams to collaborate. It's a way to extend the reach of providers, and certainly there's ample evidence that by using the technologies to bring teams together that you can improve access to care.