Telemedicine is a booming industry.
Remote patient monitoring alone in the United States is expected to be a $5 billion industry by the year 2020, according to iData Research, and most of its growth is expected to be due to telemedicine expansion. Telemedicine overall is growing rapidly, and by 2020 the use of telemedicine for disease management is expected to represent more than half of the total telemedicine market.
FierceHealthIT reports that the telemedicine market will double in size by the year 2019, with a compound annual growth rate of nearly 19% from 2014 to 2019. Technology, patient demand, and the need to contain healthcare spending are three major factors affecting the telemedicine market. Growth of telemedicine is really only limited by state licensing issues, insurer rules for telemedicine reimbursement, and the generally slow pace of legislation related to telemedicine implementation. Here are some of the ways telemedicine is changing healthcare right now.
Telemedicine in Underserved Communities
Telemedicine can fill in healthcare gaps in rural areas or areas that for whatever reason don’t have access to specialist care. Doctors are used to using medical imaging heavily in diagnosis and are less dependent on touch (such as to feel if an inflamed joint is warm) as a diagnostic tool.
The state of Oregon only has three pediatric intensive care units, and all of them are in Portland. But bedside video can be used with children who can’t get to Portland during critical medical situations. For example, pediatric intensive care specialists were able to instruct a bedside pediatrician in the resuscitation of a newborn – a procedure that must be done very carefully. Via teleconference, specialists were able to talk bedside doctors through the process successfully.
Psychiatry is another speciality where telemedicine can be used to improve patient access. In fact, telemedicine is well suited to psychiatric services, because there is a face-to-face encounter that allows connection with patients who, due to limitations of mental illness, may not follow through with an in-person interview.
Telemedicine and the Prevention of Hospitalizations
Some of the biggest cost savings that can result from telemedicine expansion come from preventing trips to the ER and preventing unnecessary hospitalizations for nursing home patients. When a person has a non-emergency medical issue crop up while away on vacation or over a weekend, telemedicine can prevent that person from having to receive expensive care at an emergency room.
Doctors can also use telemedicine to remotely examine nursing home patients and prevent unnecessary and expensive hospitalizations. When nursing home residents are hospitalized, complications are common, and Medicare spends more than a billion dollars annually on hospitalization of nursing home residents. Many nursing homes don’t have a physician on-site after business hours. When a resident becomes ill and there is a question of hospitalization, many facilities err on the side of caution and have the resident taken to the hospital. Telemedicine allowing an off-site doctor to evaluate a resident can reduce hospitalizations and provide a positive return on investment to nursing homes that invest in the technology.
Medicare and Medicaid Reimbursing More Telemedicine Services
Medicare has taken a cautious approach to reimbursement for telemedicine services, but there are indications that it may be embracing telemedicine more in coming years. The Centers for Medicare and Medicaid Services (CMS) spent nearly $14 billion on telemedicine reimbursement, with $12.48 million going to provider fees and the rest going to fees for originating sites (where patients are located).
More states are introducing bills to establish or expand payer coverage for telemedicine, and Medicare is expected to participate more in this trend. As for Medicaid, which is administered by the states, telemedicine is advancing a bit more rapidly. As of now, 43 states plus the District of Columbia offer some type of Medicaid reimbursement for telemedicine services. Expansion of telemedicine services is of interest to healthcare consumers too, as more of them realize the convenience and cost savings that can result.
Bringing Down Telemedicine Barriers to Veterans
Congress has made strides in increasing telemedicine access to veterans. For example, veterans can receive telemedicine services from VA facilities across state lines. Ordinary healthcare consumers are more restricted in telemedicine services across state lines, depending on which states their providers are licensed in. Now a new bill has been proposed in Congress that would remove even more barriers to veterans’ access to telemedicine services.
The Veterans E-Health and Telemedicine Support Act of 2015 was introduced on May 22 by U.S. Representatives Glenn Thompson (R-PA) and Charles Rangel (D-NY). This bill would allow the Department of Veterans Affairs to bring telemedicine services, including behavioral and mental health services, to veterans regardless of where they were located. Currently, the law says that both physician and veteran must be at federally-owned facilities to receive such services.
Essential Elements of Successful Telemedicine
While phone calls to and amongst doctors have long been part of medicine, the use of more advanced telemedicine, such as video conferencing, is still relatively new. However, the technology has been used enough that we’re figuring out what is necessary for it to work effectively.
Daniel Carlin, MD, founder of WorldClinic, which is an elite telemedicine “concierge” service, says that successful telemedicine requires four essential elements:
- Mobile access for patients that is easy for patients to use and that provides useful information for physicians
- Integration of all telemedicine services into a secure electronic medical record system that is reviewed by the care team. Integration should also include follow-up capabilities.
- Physicians and care team members who are sufficiently trained in the use of telemedicine. In many cases, emergency room physicians are ideal because of their skill in diagnosing and treating a wide range of conditions.
- Feedback for patients that is personalized and ideally based on medical and family history, lifestyle, and specific biomarkers
Telemedicine isn’t something from the future, but something that is very much happening right now. Legislative, reimbursement, and licensing issues are being hashed out on the state and federal levels, and more doctors and patients are realizing the benefits of telemedicine in terms of convenience and cost.
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