Where telemedicine has been, where it’s headed
Telemedicine can speed diagnoses, increase access to care for remote populations, reduce health care costs and even relieve physician shortages. Experts recently gathered to discuss what the technology has accomplished and what needs to happen to take it to the next level.
Physicians who treat patients using telemedicine in multiple states must have a medical license from each state. Since 2014, 18 states have joined the Interstate Medical Licensure Compact, designed to facilitate a speedier process with fewer administrative burdens for physicians seeking licensure in multiple states.
With the compact on track to launch in early 2017, what can be done to make telemedicine safe and practical for physicians and their patients? The 2017 AMA State Legislative Strategy Conference in Amelia Island, Fla., brought together experts in care delivery, policy and regulation to discuss the best way to move forward.
Overcoming workforce barriers
The University of Mississippi Medical Center (UMMC) began a telehealth pilot program in 2003 to link rural hospital emergency rooms and specialists at the Level 1 trauma center at UMMC. The first two years of the program were a success, said Michael Adcock, administrator of the university’s Center for Telehealth. “Since then, the program has expanded to across the state and across many different types of specialties,” he said.
Mississippi is a very rural state with “a lot of great people,” Adcock said. But it also has a lot of health disparities, illness and poverty. Though there are great primary care physicians and specialists delivering care, the main problem, Adcock said, is “we don’t have enough providers.”
So the Center for Telehealth set out with very specific goals: Deliver care as close to home as possible for patients and provide support for physicians who have a lot of patients, whether it be administrative backstopping or guidance from specialists.
The Center for Telehealth now provides services in more than 30 specialties across more than 200 clinical sites, leaving few counties in the state without access to services via telemedicine.
All stakeholders in medicine need to acknowledge “that telehealth is not a different type of health care, it is just a modality of the same care delivery,” said Kofi Jones, principal and owner of KJ Health Matters. “We need to trust physician discretion as we do in any other environment, and this is just a tool in your toolbox for delivering care.”
Telemedicine is currently moving beyond its 1.0 phase, Jones said, and the need to embrace phase 2.0 has never been greater. Telemedicine can move away from “just the urgent care … to real chronic care management [and] real integration into care delivery.”
The focus should be on “letting telehealth do its true job of helping patients stay healthier,” she said.
“In order to do that, what we really need to encourage is provider adoption," Jones said, "because, when providers widely adopt telehealth is when this technology does its best job. Not just health plans or employers or consumers. It’s when providers say, ‘Yes.’ In order to get there, we need to solve provider payment.”
As with any health care technology, physicians only ask that new tools make sense in clinical practice, are safe for their patients, do not add administrative burdens, are based on evidence and support patient-centered care coordination.
MGMA Stat recently conducted a poll asking physicians if they will offer telehealth services in 2017. Almost 17 percent of the 1,325 respondents said that they already offer telemedicine services, while 21 percent have plans to use the technology.
And the Telehealth Index survey from American Well found 57 percent of physicians are interested in seeing patients over video if it is clinically appropriate.
As long as the technology makes care more efficient for patients and is easy to use in clinical practice, physicians are willing to adopt. At the University of Virginia Health System, stroke victims who lived in the rural areas that the health system serves were at greater risk of brain damage and disability.
To address the issue, two emergency physicians designed the “telestroke” model, which livestreams the on-call neurologist into the ambulance to make an assessment and recommend treatment prior to arrival at the emergency department. With a stroke, every minute matters and the telestroke model initiates treatment much earlier.
A test of collaborative will
UMMC’s Adcock sees telemedicine as a “have-to-have” technology. “It’s necessary now,” he said. “It’s not just a nice-to-have accessory.” And it takes many players on the field to make it happen.
Establishing partnerships is one of the reasons that the University of Mississippi Medical Center has been able to expand its telemedicine program so rapidly. “Working together with not just the health systems, and not just the providers, but working with people in other industries that have leverage helps a lot,” Adcock said.
For Jones, the health care consultant, one of the critical things to fight for in partnerships is clarity. It is important, when working with health plans, to ask certain questions about payment and documentation policies. “To get to parity, we need clarity,” she said.
Sharing data is another way to work together, suggested Allison Wils, executive director of state programs and senior director of health policy at the ERISA Industry Committee, called ERIC for short. “One of the things this industry needs to do a better job of is locking arms to prove what we know,” she said.
State medical associations are in a unique position to have an impact on the legislative and regulatory environment in a way that could spark the innovation and adoption that telemedicine technologies need, the panelists said.. And as always, ensuring patient safety is a priority with all legislative and regulatory action, they added.
The AMA’s telemedicine campaign includes model bills and resources for those advocating at the state level to use.
A module in the AMA’s STEPS Forward™ collection of practice improvement strategies can help physicians use telemedicine in practice. In the module, physicians will learn the four steps to adopting telemedicine and how to navigate the benefits and challenges of remotely monitoring patients.