Expanding Access to Care through Telemedicine

When MedPeds, a family medicine practice of eight providers in the D.C. suburb of Laurel, MD, decided to venture into the world of telehealth , it wasn’t a completely novel idea. The practice, which was named winner of the 2013 Ambulatory HIMSS Davies Award of Excellence for its use of health information technology to improve patient care, had implemented an EHR nearly a decade ago and had also served as a beta site for a patient portal in 2006.

Seth Eaton, MD, adolescent and internal medicine specialist at MedPeds, says the benefits of telehealth seemed obvious—that is, being able to increase access to patient care and help patients overcome the barriers that may prevent them from being able to physically come to the office. These barriers could include distance, health or physical limitations, lack of transportation, and a variety of other reasons. Telehealth—the use of electronic and telecommunication technologies to enhance patient care—helps physicians and patients because it fills the gap and enables direct communication without necessitating the need to be in the same room, he explains.

“I see it as a way to expand access to primary care,” says Eaton. This increased access is critical not only for both rural and urban providers but also for patients who continue to enter the healthcare marketplace due to the Affordable Care Act, he adds. The supply of providers must be able to accommodate the increased demand from patients flooding the marketplace.

According to the Deloitte Center for Health Solutions 2013 Survey of U.S. Physicians, 18% of primary care physicians use telehealth for follow-up or diagnostic visits.
Rural primary care physicians have also been using the technology to obtain specialty consults in real time. Telehealth may be particularly beneficial for orthopedic practices or any surgical specialty that requires follow-up visits, says Eaton. With telehealth, a physician or physician assistant could see a patient postoperatively while the patient recovers from an injury or surgery at home. Not only is this more convenient for patients, but it’s also more efficient for providers who typically aren’t reimbursement separately for these visits after a surgery, he adds.

At MedPeds, patients currently have access to one telehealth slot per week. This ‘virtual visit’ is typically reserved for urgent issues and follow-up visits. Eaton says he eventually hopes to expand the number of telehealth slots so that every patient will have the option to either physically come to the office for a face-to-face visit or meet with their provider during a virtual encounter.

“The major benefit that I see for our practice is that if we can hire a nurse practitioner who could essentially work behind a monitor, we could generate visits that don’t require additional staff such as medical assistants,” says Eaton. “This would also add so much access for our patients.”

The New England Journal of Medicine reported in May 2013 that physicians in many specialties are starting to embrace telehealth as a way to “expand their practice, reach new patients, and potentially improve the care of patients who have historically had poor access to medical services—especially specialty services.” The article, titled “Telehealth: Changing the Landscape of Rural Physician Practice,” cites various examples of how providers, including a pediatric critical care physician, a psychiatrist, a neurologist who performs telestroke consultations, an OB/GYN, and a family medicine physician, are using the technology to improve care.

Cardiologists and electro-physiologists have embraced telehealth because it allows them to monitor patients remotely, says Rhonda Bray, RN, BSN, founder and CEO of Rhythm Management Group, a Washington D.C.-based company that provides remote monitoring for patients with a pacemaker or implanted defibrillator. With remote cardiac monitoring, a machine collects data wirelessly and then transmits it to an EHR, or a company such as Rhythm Management Group sends the information to the provider within 24 hours. Bray says her company is in the process of interfacing with various EHR vendors so providers can automatically view the data.

Nearly one million Americans currently use remote cardiac monitoring, according to the American Telehealth Association. Bray says physicians like the technology because it allows them to intervene more quickly. “If a patient has a new onset of a heart rhythm disturbance or their battery is wearing down or if the wires are failing, we can catch that early and alert the physician,” she says.

Patients like the technology as well because they’re able to stay at home while being monitored 24/7. “These devices are so sophisticated now that they’re on auto pilot. They self-adjust. There’s really no good clinical reason to bring patients in [to the office] every six months,” says Bray.

In addition to enhancing the access to and quality care patient care, telehealth also enhances patient satisfaction because it gives patients options in terms of how and where they can receive care, says Eaton. Although patients in the Laurel community are slowly embracing the concept of virtual care, Eaton says he hopes they will take advantage of it more frequently over time just as they have gradually accepted the practice’s portal technology.

How to get started with telehealth
If you’re thinking about offering telehealth in your practice, consider the following tips:

• Shop around for a vendor. Eaton says there are an overwhelming number of vendors that offer telehealth technology, some of which are more geared toward hospitals rather than physician practices. Many vendors charge a monthly fee for an unlimited number of visits. The American Telehealth Association provides a helpful telehealth buyer’s guide that practices can use to find a vendor that’s suitable for their particular specialty.
• Look into reimbursement limitations. According to the American Telehealth Association, almost every state Medicaid plan covers at least some type of telehealth services; however, this coverage varies greatly by state. Medicare covers telehealth only in certain circumstances, such as remote radiology, pathology, and some cardiology. It also covers videoconferencing for beneficiaries living in rural areas. Private insurance coverage for telehealth service also varies by state. Eaton says there is a state mandate in Maryland that requires all insurers to cover telehealth in all instances. “We’ve never had a single denial,” he adds.
• Consider legal issues. The National Telehealth Policy Resource Center outlines several legal implications for telehealth that providers must address.
• Identify a physician champion. As with any technology implementation, practices that succeed are those who identify a physician champion who can help other providers learn how to use the telehealth technology and incorporate it into their workflow.

Find out more about how the demand for healthcare services will be changing in the coming years on this infographic, Healthcare Demand is Growing: Are You Ready?

Are you using telehealth or considering it? Share your thoughts in the comments.