Good Reasons to Use Telehealth

This is not something many doctors or patients consider, but telehealth is coming whether they want it or not. I have recently talked to several doctors and asked them about using telehealth. Most are very negative in their answers and clearly showed no interest. One doctor (a hospital employee) said the hospital would not allow it and another said the head of the clinic he was part of was against telemedicine of any kind.

The hospital doctor said they would allow doctor-to-doctor consultations if it became necessary, but not doctor to patient. I did give a printout of this article and he read it. He said this would be something he would present at the next meeting with the administration and the fact that a doctor was talking would be good. He was impressed with the first two points and felt that these should be good for all the hospital doctors.

He gave me his home email address and asked me to send any more information I could find, which I have done for three other articles.

Peter Antall, MD says, “Telehealth is here to stay — consumers want it, health systems are adopting it, health plans are reimbursing for it, and frankly, there’s already a lot of great work being done by innovators like Cleveland Clinic.”

At the same time, there are a few, specific reasons why you’d want to practice telehealth. Here are five: (as listed by Doctor Antall)

1. Get paid for things you’re probably already doing for free. A lot of doctors spend time throughout the day making phone calls, answering secure messages to patients, as follow-up, or regarding new conditions. What’s great about telehealth is that you can conduct this type of outreach over video, have a more robust visit, and get reimbursed for the care that you deliver. Why not monetize these phone or text-based interactions through telehealth while providing a service that your patients want and need? You should be getting paid for the hard work you do and with telehealth, you can.

2. Improve access to care. The use of telehealth allows you to offer improved access for acute problems both during and after office hours. You and your colleagues can provide the staffing, or you could work with an online medical partner to augment your services. Patients who are unaccustomed to the experience of being able to see a board-certified physician in the wee hours of the night when dealing with a sudden issue will be thrilled to have on-demand care, provided by you. This also improves continuity as these acute conditions are all cared for under your practice and brand, rather than by the ER or local urgent-care center. This naturally builds loyalty to you and your practice, and more importantly, keeps your patients with minor conditions out of the ER.

3. Make better use of mid-level and support staff. Telehealth can vastly improve your triage services – video can be utilized by your nurse or medical assistant when assessing new complaints. These patients can then be triaged to home care, a telehealth visit with a provider or a brick and mortar visit. Telehealth can also be used for pre- and post-procedure consultations. A good example is a conversation I recently had with a pediatric surgeon. When the surgeon asked me, “Why should I do telehealth?” my answer to him was easy — you can do more procedures. You can let your physician assistants and nurse practitioners do the pre- and post-op follow-up by video, leaving you more time in the operating room.

4. Enjoy real care coordination without all the hassle. Telehealth can also be used to show specialists and other allied providers right into your office. Increasingly telehealth is being used for provider-to-provider consults or to facilitate team-based care. Instead of giving a patient a referral to go see a certified diabetes educator, dietician or specialist in the area, hope they follow your guidance and hope that you will get a report back. With telehealth, you can invite these providers to see the patient right in your office.

5. Make your patients' lives easier (and improve compliance) by eliminating unnecessary in-person visits. Visits for medication management are particularly amenable to telehealth. These visits are not reimbursed when performed by phone and it seems silly to drag patients into the office — with transportation, parking, and the usual wait in the waiting room — when these visits can easily be done through telehealth. Why bring in an ADHD patient to talk about how school is going when you can see them remotely, in their home, on their couch? Elderly patients who may suffer from limited mobility can have a visit for medication adjustment without having to make travel arrangements.

Other more obvious benefits to practicing telehealth in and outside the clinical setting include better work-life balance, differentiation for your practice, the ability to take on disease management, increased geographic range, and the ability to build new programs.

Many medical practices are losing money when they refuse to consider this and ignore the desires of their patients. Plus, when another practice starts using telehealth, these patients will transfer.

ACA Will Help Spark Boom in RPM

RPM means remote patient monitoring and will be here to stay under the Affordable Care Act (ACA). Initially this started with heart patients, but it will expand. And yes, diabetes is on the list of types of patients that will be remotely followed. Now why would they do this, considering that few type 2 diabetes patients receive education on managing their diabetes? Not only that, but without the personnel available to educate people with diabetes, how can they expect patients with type 2 diabetes to feel anything but contempt for remote patient monitoring.

I expect to see something appear in the American Diabetes Association (ADA) website as early as this summer hinting at the possible monitoring to be done and when it will start. Then, I am guessing that the ADA 2014 guidelines will have much more to say about this. If not this summer, then announcements will happen by the summer of 2014 and will be part of the ADA 2015 guidelines. It is coming and of this, I have no doubt.

This press release says a lot about RPM for five major chronic illnesses that will grow by 6-fold by 2017. This is because the ACA will be pushing hospitals and physicians to stop the revolving door treatments by hospitals. In 2012, clinicians reviewed remote patient monitoring data for about 227,000 patients with congestive heart failure (CHF), chronic obstructive pulmonary disease, diabetes, hypertension, and mental illness. The figures include a number of other patients with asthma, coronary artery disease, and hemophilia.

CHF patients were almost half of PRM in 2012. In 2017, diabetes will overtake CHF and the monitoring will grow by 67.5 percent from 2012 to 2017. The next fastest group of RPM will be patients with mental illness. Demand for this monitoring comes from patients and private insurers, which seek to reduce costly hospitalizations. All of these trends build on an even larger one, an aging population beset with chronic conditions.

The ACA will bring financial incentive into play to promote RPM and this will mean rewards for physicians and hospitals that comply. In addition to sharing payment for an episode of care, they will earn a bonus, or take a pay cut, depending whether they come under or exceed a cost target. With the financial incentives and penalties that the ACA can and will enforce, hospitals and physicians will have money reasons to physically monitor patients. Then there are those providers that want to remotely patient monitor at home for improved care whether there are monetary rewards or not.

The one factor not included in this article if the role of the Food and Drug Administration and how fast they will be approving these remote monitoring devices. This could be the flaw in the current thinking, but this should not delay progress for long as CMS and most insurance payers are on board and looking to the benefits this will provide.

Currently, the task of reviewing RPM data falls to nurses at third party triage and call centers services. They then alert the relevant physician to flagged changes. Currently, under the existing fee-for-service reimbursement, there is no incentive to take remote medical data that will not result in a billable office visit. Under the ACA, there will be many financial incentives for physicians to change their way of doing business including penalties.

Presently, remote-monitoring systems are relegated to call centers, but this will change as pressure is put in place for the electronic health records (EHR) to be capable of tracking this data. Yes, the manufacturers of EHR systems are balking; however, congressional pressure is being applied quite liberally to force them to make their systems more responsive to receiving RPM data and working together (interoperability) to correspond with competing EHR systems. This can only be positive as the Health and Human Services and Centers for Medicare and Medicaid are applying pressure saying their systems will not meet useful standards, as they exist. The pressure is to make all systems “telehealth-ready.”