In a recent article in EHR Intelligence, InTouch chairman and CEO Yulun Wang made a simple yet profound observation about healthcare’s so-called “triple aim”: the only way to increase access, improve quality and lower costs is with telemedicine.
In his view, telemedicine has a vital role to play in both preventive care and acute care. Telehealth technology helps monitor patients with chronic diseases, making it easier to prevent problems before they spiral out of control. And when acute care is needed, telemedicine helps ensure that the right expertise gets to the right place at the right time.
Here’s how telemedicine – and only telemedicine – can achieve the triple aim in the fictional community of Needadoc, Idaho, population: 700.
Access and Quality – In Needadoc, the nearest neurologist is 280 miles away. It would take four hours to transport a stroke patient that far, which means that tPA could not be administered on arrival. But with telemedicine, the patient can be seen by a topnotch neurologist in a matter of minutes – without even leaving town.
Cost – Many rural hospitals have become “stabilize and ship” facilities. If they lack the expertise to provide care locally, Medicare (or other payers) must foot the bill for transporting patients to a larger hospital. But with telemedicine, the patient gets high-quality care close to home. Transport costs drop dramatically, and more revenue stays in the community hospital. Tertiary care hospitals benefit financially, too, by avoiding the cost of treating transported patients who don’t require admission.
Whether you call it “value-based care” or “triple aim,” there’s simply no way to get there if you take telemedicine out of the equation.
The Federation of State Medical Boards (FSMB) recently released its final version of an interstate medical licensure compact that makes it faster and easier for physicians to get licensure in multiple states. Although the compact doesn’t meet all of ATA’s goals, it’s certainly a step in the right direction.
The compact allows physicians to obtain an “expedited” license in states other than their own without having to provide the massive documentation required in a formal application. Physicians would still have to pay a hefty fee (up to $2,000) for each expedited license.
To take effect, the FSMB compact must be approved by seven state legislatures. That should be fairly easy to achieve in 2015, since three state medical boards have already approved the compact and others are leaning that way. Very few legislatures are willing to buck their own medical boards.
The compact will help streamline multi-state licensure not just for doctors practicing telemedicine but for the thousands of locum tenens physicians who take short-term assignments in underserved communities across America. The compact will also make life easier for physicians whose service area straddles multiple states, like those in Washington, D.C., Memphis and Kansas City.
The compact falls short of the ATA’s desired goal: a single medical license honored across all 50 states. Both FSMB and the American Medical Association still staunchly insist that a physician must be licensed in the same state as the person receiving care. That’s like requiring a Seattle stockbroker to get additional licenses for helping clients in Florida and New York.
Although the compact isn’t perfect, it shows that attitudes are changing quickly. The fast-track licensure gaining momentum will hopefully pave the way for the ultimate prize: one license honored in every state.
You could call it a “tipping point.” A recent study by the Affiliated Workers Association found that more than 36 million Americans have already used telemedicine in some fashion. And now a tech entrepreneur is helping to make telemedicine downright trendy.
Oscar Salazar, a former engineer at on-demand car service Uber, has introduced a new iPhone app called Pager that’s available now in New York City and soon in Boston. The app lets users search for the nearest available doctor, just like Uber looks for cars. The screen display shows the doctors’ photos and specialties. Phone consultations cost $50 and house calls are $300 (which is only slightly higher than the cost of an urgent care clinic visit). And best of all, these on-call docs are available from 8 a.m. to 10 p.m. every day of the week.
The Pager app isn’t meant to put hospital EDs out of business. It’s primarily designed to relieve wait times at walk-in clinics (which can be quite lengthy in Manhattan).
Pager is already getting some serious competition. The Medicast app does pretty much the same thing for people in South Florida, Los Angeles and San Diego. Then there’s the new Virtual Visits platform from Verizon, which is selling the technology to providers and employers who then offer the apps to their patients and employees. This allows any smartphone user (not just Verizon customers) to conveniently consult with doctors and get prescriptions and referrals.
A century ago, roughly half of all doctor visits were house calls. But by the advent of Medicare, the house call had all but vanished (just like pay phones have disappeared in U.S. cities). But Pager reminds us that it’s refreshing to interact with a physician in a non-clinical setting. It’s a whole lot better than reading magazines in a cramped waiting room.
The Sepsis Alliance has designated SEPtember as its Sepsis Awareness Month, and Sept.13th as World Sepsis Day. We’ve blogged before about telemedicine’s role in early detection of sepsis, but it’s a topic worth revisiting.
Sepsis is caused by complications from an infection, and 100 years ago it wasn’t much of a problem worldwide. But today, many seniors in their 70s and 80s are having major surgeries that weaken their already fragile immune systems making them vulnerable to infections. That’s why most cases of sepsis occur during hospitalization. Each year, more than a quarter of a million people die from sepsis – and it costs the U.S. healthcare system $20 billion annually.
Advances in pharmacology are making the problem worse by potentially making millions of people more prone to sepsis. You’ve probably seen pro golfer Phil Mickelsen’s TV ads for Enbrel, a rheumatoid arthritis drug that alleviates inflammation but also weakens the immune system. There are similar drugs that combat other types of arthritis, psoriasis and a host of other ailments – most of them marketed to seniors in well-funded TV campaigns.
People who take these medications – particularly those who already have diabetes, HIV or chronic liver or kidney problems – are more susceptible to sepsis. As we reported several months ago, a significant number of sepsis deaths occur in non-ICU settings. That’s where telemedicine can help. By monitoring more patients at home, and matching their data with the hundreds of sepsis “red flags” we know about, many sepsis cases can be prevented.
The Missouri-based Mercy Health system already has a TeleSepsis program where community caregivers consult with sepsis specialists at the hub hospital. The program has dramatically lowered ICU costs and, more importantly, produced a nearly 50% reduction in sepsis deaths.
This September, let’s pause to remember that teamwork and telemedicine are helping to reduce the staggering costs and number of deaths from sepsis.
Telemedicine opponents often claim that patients aren’t comfortable interacting with a remote physician. But that’s utter hogwash if you look at the latest research and market trends.
Telehealth companies that offer remote consultations via smartphone apps are growing by leaps and bounds. Even big-name health systems are getting into the act. Last year, Cleveland Clinic performed nearly one million remote consultations by smartphone and e-mail. That was done primarily to meet the needs of millennials who would rather get a same-day smartphone consultation than wait weeks to see a doctor. But a growing number of Boomers are also quite comfortable getting a tele-consult rather than enduring the long wait and high cost of the ER. It’s also handy when people are traveling and don’t want to see an unfamiliar physician at an urgent care clinic.
Several recent studies show just how quickly remote consultations are gaining acceptance. A new study from MDLIVE found that a whopping 82 percent of adults, age 18 to 34, feel that a smartphone consultation is the best option, not just an emergency choice.
That’s confirmed by Intel’s recent Healthcare Innovation Barometer, which found that 72 percent of those surveyed were happy to see a doctor via video-conference or mobile device for non-urgent cases. Worldwide, 84% of respondents said they would gladly share personal health data remotely if it could help lower healthcare costs.
And here’s a sure sign that people trust Big Data: more than 70 percent of those surveyed globally are willing to use toilet sensors, prescription bottle sensors, and even swallowed monitors to make remote diagnoses faster and easier.
These findings are the perfect rebuttal to stodgy organizations that gather anecdotal evidence and make the phony claim that people aren’t ready for telemedicine.
Bryan Coffey, CEO of Hamilton County Hospital in Syracuse, Kansas, recently had a guest commentary in Modern Healthcare outlining the many benefits of remote presence technology in the rural hospital setting.
This Critical Access Hospital (CAH) is located in a rural stretch of Kansas that’s a one-hour drive to the nearest Walmart store. Yet they’re using an RP-Lite to perform some amazing things like:
- Telestroke consultations in partnership with hospitals in Denver and Wichita
- Remote access to specialists in pediatrics, obstetrics and dermatology so patients don’t have to drive eight hours each way to see a specialist
Since acquiring the robot, the hospital’s volumes have increased 30 percent over the previous year – and Medicare outpatient reimbursement has increased by 16 percent.
In the article, Coffey notes that any critical access facility can afford remote presence because of Medicare’s cost-based reimbursement. In his estimation, if a CAH has just one patient per month remain in the hospital versus getting shipped out to a larger facility, the hospital has more than paid for the robot that month.
Coffey has written a case study that provides a complete analysis of how a CAH can cost-justify both a telemedicine robot and contracts with telemedicine providers. It’s a great resource for CFOs at small hospitals, going line by line through things like Rural Health Clinic cost reports.
When Coffey first weighed the telemedicine option, he ran the numbers by some experts at two of the top healthcare audit firms. They took a close look and agreed: telemedicine is a solution that makes financial sense for any critical access facility in the nation.
There are plenty of ways to squander millions of dollars. Making a movie of “Hamlet” starring Vin Diesel is one. Launching a new search engine to compete with Google is another.
But nothing is sadder than the spectacle of a healthcare system blowing millions of dollars on an Electronic Health Record or other technology venture without getting input from clinicians. When these projects get turned over solely to hospital IT people, it’s a runaway train of quality nightmares and cost overruns.
Take, for example, the case of Athens Regional Medical Center in Georgia, which partnered with Cerner (one of the biggest and best EHR vendors in the business). Both Cerner and hospital physicians complained that there wasn’t enough upfront clinical guidance, but hospital leadership didn’t hesitate in handing the reins to the IT staff.
How bad did things get? A recent news story from The Advisory Board chronicled some of the mishaps, including numerous medication errors and one admitted patient who didn’t see a physician for five days.
As the multimillion dollar fiasco continued, both the hospital CEO and CIO got axed. Now, with Cerner’s help, the hospital is starting over and getting plenty of physician help. This underscores a basic truth in healthcare technology: most projects require comprehensive planning and are the shared responsibility of clinicians, hospital operations, and the IT staff. A “go it alone” strategy usually backfires.
What happened at Athens should be a wake-up call for healthcare systems that are considering “homegrown” telemedicine programs. Letting the IT staff make an investment in videoconferencing carts is not a telemedicine program, which requires just as much planning and clinical input as an EHR.
When IT plays the role of conductor – and clinicians are left in the caboose – there’s no stopping that train until something bad happens.
At the dawn of the computer age, there were all sorts of Orwellian predictions that humans would one day be frightened and oppressed by these awful machines. But now that computers are part of the everyday fabric of life, studies show that many people prefer digital interactions over human encounters.
Case in point: being completely honest with your doctor. Who among us hasn’t told a few fibs to our friendly physician? Things like “I’m going to the gym four times a week” and “I haven’t been to Krispy Kreme in over a year.”
In some studies, nearly one third of patients say they haven’t been totally honest with their physicians – and most doctors feel the percentage of truth-benders is much higher than that. This obviously makes it far more difficult to make accurate diagnoses.
It should come as no surprise, then, that a recent study in Computers in Human Behavior found that patients are more honest with “virtual humans” than with their real-life physicians. They’re much more willing to disclose personal information because there’s no embarrassment or fear of disclosure.
These findings echo a study in JAMA Surgery that found that two-thirds of patients in post-operative surgical rounds prefer to see their own doctor via “telerounding” technology rather than get an in-person visit from a physician they don’t know.
The old science fiction predictions about menacing computers and robots wanting to probe your mind (and other parts) have proven to be ludicrous. Remote presence technology is helping to capture and share patient information that’s often more honest and accurate than face-to-face encounters.
A new JAMA study confirms that the sepsis problem in U.S. hospitals is growing dramatically worse. Although sepsis occurs in just 10% of hospital patients, it’s responsible for about half of hospital deaths.
These findings are giving new impetus to the field of TeleSepsis, which is already helping to reduce sepsis mortality and hospital length of stay.
Remote presence can indeed play a preventive role because sepsis is not exclusively an ICU issue. Kaiser Permanente Northern California recently tracked six million hospitalizations and found that more than half of sepsis deaths were in patients with less severe cases, many of whom were treated in non-ICU settings. The study also revealed that sepsis was often present at time of admission.
Here’s how the Missouri-based Mercy system (highlighted in our previous blog) is using remote monitoring to look for warning signs of sepsis in the community setting:
Some sepsis cases can be identified prior to hospitalization by monitoring patients at home. The data gets uploaded to Mercy’s electronic health record, which has 800 red flags to spot patients at risk for sepsis. The team then alerts the local doctor, who takes the right actions to prevent it.
For patients already admitted to Mercy’s network affiliate hospitals, those who are at risk are placed in a virtual sepsis unit for closer monitoring. Caregivers at the outlying hospital can remotely consult with specialists at Mercy’s hub facility, who help identify patients who need an IV replacement or may be at risk for blood clots.
Modern Healthcare reports that Mercy’s TeleSepsis program has produced a nearly 50% reduction in deaths from sepsis – and is saving $25 million annually by reducing ICU length of stay.
For most hospitals, the sepsis crisis is deadly and expensive. TeleSepsis may be the magic bullet we’ve been waiting for.
The 42-hospital Mercy system based in the St. Louis area recently announced plans to build a $50 million virtual care center – a 120,000 ft. command post that HealthLeaders reports will offer 75 telemedicine programs to serve more than three million patients.
This is truly a Big Deal in capital letters – similar to a large medical center announcing a prestigious new cancer institute or cardiac hospital. It’s pretty obvious that telemedicine has arrived as a standard of care when a leading healthcare system makes an investment of this magnitude.
When completed next year, the virtual care center will house 300 physicians, nurses, specialists and IT staffers. Their task: to bring quality healthcare to the vast expanse (mostly rural) of Missouri, Kansas, Oklahoma and Arkansas. Mercy serves many communities that lack specialists of any kind – and are often short of primary care physicians, too.
Even though Mercy already offers a comprehensive range of telemedicine services, the system keeps piloting new initiatives (like its new pediatric behavioral health program that lets kids get top-quality local care and offers big-time savings on transportation).
When Mercy holds its formal ribbon-cutting ceremony next year, it will truly be a watershed event in telemedicine history. A major healthcare system in the “Show Me” State is about to show all of America that telemedicine has the power to transform healthcare delivery.