In many regions, telemedicine started out as a way to bring specialized healthcare services to people who live in remote areas.
In fact, Medicare has reimbursed limited telemedicine services in rural areas for several years. Medicare treats telemedicine mostly as a tool for rural areas, and has strictly defined geographic areas eligible for it. At first, the only people for whom Medicare would reimburse telemedicine services were located in designated Health Professional Shortage Areas in counties outside Metropolitan Statistical Areas. In 2014, however, the Centers for Medicare and Medicaid Studies (CMS) began allowing telemedicine in Health Professional Shortage Areas even if they were located within a Metropolitan Statistical Area.
Large western states like Idaho are discovering they could benefit enormously from increased telemedicine access. The state passed a law in March allowing for telemedicine services after a healthcare provider has documented the patient’s clinical history and current symptoms “to establish the diagnosis and identify underlying conditions and contraindications to the treatment recommended.” The law allows for online, video, and phone-based telemedicine services. Idahoans are hopeful expanded telemedicine access will address looming healthcare problems in the state.
Problem: Increased Medicaid Spending
In the ten years between 2002 and 2012, Medicaid spending in Idaho increased by over 50%. In 2002, Medicaid spending made up just under 18% of the state budget, but by 2012, it made up over 27% of the budget, having peaked at 28.5% of the state budget in 2011. Currently, 47 states’ Medicaid programs reimburse providers for telemedicine services. Though specifics vary by state, Medicaid reimbursement for telemedicine generally covers:
- Office and outpatient visits
- Individual psychotherapy
- Psychiatric diagnostic interview exams
- Pharmacologic management services
Medicaid reimbursement for services can make a substantial difference in access to care in states with large rural expanses. Providers can treat patients remotely without a lot of overhead or extra time, and patients can access care without driving long distances or arranging to be taken to a facility in a city.
Problem: Higher Insurance Premiums
Nationwide, health insurance premiums have increased faster than the rate of inflation for many years, and Idaho is no exception. According to a Commonwealth Fund study, Americans whose families are insured through their employers have experienced annual premium increases that have significantly exceeded wage growth for more than ten years. In fact, premiums went up three times faster than wages between 2003 and 2013.
Additionally, out of pocket costs for health insurance premiums are up, as is cost sharing. In other words, not only did people’s premiums rise rapidly over the past decade, their out of pocket responsibilities increased as well. Employees insured through their employers have been asked to pay increasingly larger chunks of their premiums, and per-person deductibles have more than doubled in most states as well. In Idaho, coverage for a family of four increased in cost by 82% from 2003 to 2013, and Idaho had among the lowest costs in the country. Currently, premiums cost 22% of the median income for single people and 21% for families (though employers may pay some of this share), which is more than people pay for food and clothing combined.
Problem: Shortage of Primary Care Physicians
With implementation of the Affordable Care Act (ACA), there are fewer uninsured people, meaning more people seek the services of family practice and internal medicine physicians. There’s already a well-documented physician shortage in Idaho, with the state ranking last in the US for the number of primary care physicians per person. Many primary care physicians are retiring, and there’s no medical school located in Idaho, two factors that contribute to the increasing shortage of primary care doctors there.
Implementation of the ACA is expected to result in a 10% to 25% increase in the number of primary care physicians needed in the state of Idaho. Rural communities are particularly hard hit by the physician shortage. Increased telemedicine access should help, by allowing people to get care without driving long distances and allowing existing physicians to increase patient load without undue staffing burden.
Problem: Specialist Access in Rural Areas
Rural areas often have a shortage of specialists, particularly in emergency situations, but telemedicine is able to alleviate some of this by allowing doctors from major medical centers to use secure video conferencing to consult with physicians in rural areas. The benefits are many. For one thing, telemedicine can prevent some emergency transfers and the stress and costs associated with them. For another, patients can often be treated closer to home, lightening the burden on family and caregivers.
And specialist emergency telemedicine services can be delivered far more rapidly than the time it takes to transport a patient from a remote area to a major medical center. Idaho covers nearly 83,000 square miles, and the population in 2014 was estimated at 1.6 million. Of these, 548,000 Idahoans live in rural areas. Better access to telemedicine should benefit these rural residents significantly.
Problem: Access to Mental Health and Substance Abuse Counselling
Large western states have also had success using telemedicine to assist with mental health and substance abuse counselling. The state of Washington offers grants to community health center partners for integrating behavioral healthcare into primary care clinics. Behavioral health coordinators triage patients during primary care visits using standard mental health screening tests. Results are entered into a web-based patient registry. The coordinators then meet weekly with a consulting psychiatrist via phone or video conference to determine the appropriate care for patients based on their profiles.
Continued monitoring, additional screening, or a patient consultation with a specialist via secure video conference may be arranged. The program has recently been expanded to address people with substance abuse problems. Since the state of Washington has a shortage of psychiatrists, particularly those who focus on substance abuse, the telemedicine program helps make the most of the resources available.
With demand for healthcare increasing and an aging population, telemedicine expands access, allowing people to save time and money for many healthcare services. At eDrugstore.com, we understand the importance of providing medical services at a distance. We work with US-licensed pharmacists to dispense name brand medications to customers and have been doing so for 15 years. We’re dedicated to outstanding customer service and protection of privacy, with quick shipping and friendly, professional service.
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