Earlier this year, a recent audit from the Government Accountability Office (GAO) in the US showed that Medicare’s payment and coverage restrictions are largely responsible for holding back progress and access to telehealth services, including in the ER. Government moves slowly, but that doesn’t mean hospitals and medical centers do, and more and more are now conducting trials and implementing telehealth solutions.
Because they make sense. Being able to reach a specialist using a secure video conferencing application, for example, which has been integrated with Electronic Medical Record systems, can mean the difference between life or death, while also improving overall outcomes and reducing costs over time.
Telehealth is gaining more and more traction in the healthcare industry, with 2017 as a banner year given faster internet connections, the ubiquity of smartphones and other personal devices, and new commercial software platforms that more easily connect patients with providers, while remaining compliant.
Patients also are becoming more aware of telehealth as well. A study commissioned by NTT Data Services found that 74 percent of patients said they would use a telemedicine service if available. And another study found that 20 percent of patients, or as many as 50 million, would switch to a different primary care provider if that meant access to video visits.
A different study, by the American Academy of Family Physicians, revealed nearly 80 percent of physicians polled believe the use of telehealth improves economics, access and quality of care – while only 15 percent of those same physicians having used the technology.
We all know – this is inevitable.
And we at Telemedco believe one of the best places to start telehealth programs is as part of the emergency medicine offering.
Based on the research we’ve conducted a we have been building our new telehealth and imaging solutions specifically for ER use, is that some form of this technology has been in used in ERs for the last decade.
The American College of Emergency Physicians (ACEP), teleradiology is one of those services.
“Teleradiology is a branch of telehealth in which radiologists provide remote reporting on radiologic images,” explains Neal Sikka, M.D., FACEP; Sara Paradise, M.S.I.V.; and Michael Shu, M.S.I.I., George Washington School of Medicine in their “Telehealth in Emergency Medicine: A Primer.” “The field has been widely used for more than a decade, providing a good example of the rapid change in infrastructure and the results of transitioning from an on-site to remote form of communication.”
Several hospitals and healthcare systems we are in discussions with are currently using or piloting programs in their emergency departments to triage patients, reduce wait times, extend care remote areas, and even provide extremely efficient and cost-effective routine care to patients.
New York-Presbyterian Hospital, for example, earlier this year began marketing NYP OnDemand, a multi-use platform that accommodates virtual ER visits for patients with non-life-threatening conditions.
According to a recent Modern Healthcare article, “Tapping Telehealth for Complex Cases,” patients utilizing NYP OnDemand go to a private room and have a video visit with an ER physician who’s sitting in another office just 200 yards away. Visits average about 30 minutes.
A Wall Street Journal article about the same program, “Can Tech Speed Up Emergency Room Care?” explains that all patients who come to the emergency department receive a “standard, in-person emergency room triage—where a nurse practitioner or physician assistant screens them.”
“Meanwhile, doctors can now treat patients from more than one hospital from their desk, and pivot to their administrative tasks more quickly in between visits,” said Rahul Sharma, the emergency physician-in-chief at Weill Cornell (also located in NYC), because patients have a full triage and medical screening exam.
While progress is being made on reimbursement for virtual visits, policies and insurance company rules vary widely depending on the county, state and federal views, as well as the hospital systems’ own biases.
Payment for telehealth varies widely by state, payer. Medicaid programs in every state offer payment for some telehealth services, and 31 states plus the District of Columbia require reimbursement for some level of telehealth services.
Medicare, on the other hand, restricts telehealth payments to cases in specific geographical and clinical sites.
New York-Presbyterian’s program figured out how to pair video conferencing with in-person care, making the rate the same for the physician or nurse in the room physically, and the expert attending virtually.
RAND Corp.’s March Health Affairs study this year reported that direct-to-consumer telehealth visits on average are usually cheaper than standard care and run about $40 to $50 per visit.
In the ER, enhancing care with telehealth systems is – an emergency! Why? The wait times are growing, costs are skyrocketing out of control, care teams are overwhelmed, and triage can be dramatically improved with software enablement, which we’ve seen through the development of our first solution, working with IBM Watson.
While telehealth services already are included in the Merit-based Incentive Payment System’s performance criteria, it may take passage of a bill quietly introduced in the US Senate in March, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, allows payment for telehealth services for patients with chronic conditions.
When Medicare agrees to reimburse for telehealth, including in the ER, we will see a dramatic increase in innovation, implementation and ultimately better results, lower costs, and data that will help improve emergency care over the long run.
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