Taking a Second Look at Telemedicine

By Nancy Wurtzel

Physician shortages and declining reimbursement are causing the healthcare industry to consider innovative alternatives for delivering patient care.  One method, Telemedicine, which was introduced in the early days of the internet – with mixed results – is now getting a second look.

Telemedicine can be described as a real time, interactive, and electronic communications between a patient and practitioner.  Its purpose is to improve the patient’s health.

Initially, telemedicine was billed as “virtual house call,” allowing patients to bypass a traditional office visit in favor of a real-time audiovisual connection between doctor and patient.

The idea had real potential, but the reality didn’t live up to the hype.

A big hurdle at the time was the technology itself – it wasn’t sophisticated enough to support the concept of telemedicine.  Consequently, physicians and patients often had problems communicating due to poor internet connections or unreliable equipment.

Health care providers were also slow to embrace telemedicine.  Rightly so, providers were reluctant to diagnosis and start a course of treatment without seeing the seeing the patient in real time.

Those who did embrace telemedicine were mainly for-profit companies.  A typical telemedicine service was aimed at busy professionals and other consumers who needed medical advice, but also desired convenience.  Their fee-for-service model bypassed insurance companies and sometimes skirted state and local regulations by labeling their service as “providing information” rather than medical advice.

For their part, patients often reported being dissatisfied with their telemedicine experience.  Many received a wrong diagnosis, or they went through the entire process only to be told they would need to see a doctor face-to-face to get a prescription, test or other course of treatment.

However, much has changed in recent years.  Technology, for instance, has improved significantly, plus patients are savvier about how to use it.

Many providers are also embracing technology to help them manage more patients as well as the rural population, which may not have access to needed healthcare.

Today’s telemedicine is growing at a steady pace.

Melinda Beck, wrote in the Wall Street Journal: “The American Medical Association (AMA) endorsed the use of remote monitoring and delivery of services at its annual meeting in June 2014. The organization also noted that the market for telemedicine is expected to grow from approximately $1 billion in 2016 to $6 billion by 2020. The move by the AMA, along with support from the Federation of State Medical Boards, is helping pave the way for fewer restrictions to telemedicine across the United States.”

Perhaps the time has come to reconsider telemedicine. But how can providers implement it?

Telemedicine works best when incorporated into a traditional patient/physician relationship.  In this setting, the patient and provider have the confidence to work together, and the provider has access to the patient’s medical history.

While individual providers need to operate within their comfort zone, some examples of appropriate telemedicine appointments would be when a physician needs to convey and interpret test results, review medications, conduct a post-treatment check-up, and monitor chronic care cases.

Here are a few considerations for a successful telemedicine appointment:

• If the patient and provider need to communicate, but do not have to be in the same room, then a telemedicine setting is appropriate.
• A good audio/visual connection is vital.
• The patient must have the cognition skills to articulate his or her health concerns and then follow doctor’s advice.
• Ahead of time, ask the patient to fill out online forms and to prepare a list of questions and/or concerns.
• If the doctor or the patient has doubts, then a face-to-face appointment is needed.
• Parameters of telemedicine vary from state-to-state, so providers must be aware of any local requirements.

The potential for telemedicine appears to be enormous, but money is a major issue holding providers back from fully embracing the technology.

Many insurance companies are not reimbursing for telemedicine appointments. “It’s very hard to get paid unless you physically see the patient,” said Dr. Peter Rasmussen, a neurosurgeon and medical director of distance health at the Cleveland Clinic.

The healthcare industry may be catching up.

Over 30 states now have “parity” laws that help doctors be reimbursed for services delivered remotely if these same services would be covered by insurance if the patient were seen in a traditional office visit.  The caveat is that insurance coverage may not be at the same rate and the frequency may be limited.

A few major insurers such as Anthem and UnitedHealth Group have also jumped on the telemedicine bandwagon.  They are offering their own version of direct-to-consumer virtual doctor-visit services, by making their physicians available for telemedicine appointments for chronic disease management, urgent care visits, and virtual follow ups.

American industry has also taken note of the benefits of telemedicine.  In 2016, 74 percent of large companies offered their employees telemedicine benefits.