More Schools Using Telehealth

A recent article in the Washington Post shows that telehealth is gaining popularity in American schools, but state laws are slowing its implementation. Consider that:

  • More than 30 states still don’t authorize Medicaid reimbursement for telehealth services provided in schools.
  • Some state Medicaid programs only cover telehealth if a doctor or nurse practitioner is at the school – and most schools are staffed by registered nurses, not NPs.
  • School telehealth is largely limited to primary care/pediatric cases, although New York and South Carolina are using it for mental health, and Michigan uses it for speech pathology.

Yet there are many success stories to share. Missouri state legislator Kip Kendrick helped pass a law allowing Medicaid payments for K-12 telehealth. “School telehealth will be a game-changer in children’s health, keeping them in school and improving educational outcomes,” he says.

The benefits of K-12 telehealth to date fall into three main buckets:

Quelling flu outbreaks – Before telehealth, Sevier County, Tennessee schools experienced annual school closings due to flu. Since the arrival of telehealth, there have been five straight years with no flu-related school closings.

Improving individual attendance – With telehealth, a child who leaves an asthma inhaler at home can be seen promptly by a doctor and given medication at school rather than having to go to an ER.

Reducing missed work time – When a student sees a doctor via telehealth, parents don’t have to leave work for office visits.

So let’s applaud states like Maryland, Missouri and South Carolina that are tapping the full potential of school telehealth. And here’s our message for the lag-behind states: you’re missing some great opportunities.

Removing Telehealth Barriers With National Licensing

Our new President is billed as a pragmatist, not a politician. That’s why healthcare leaders are calling on Mr. Trump to make medical license portability the law of the land.

In an open letter to the President from Federation of State Medical Boards (FSMB) CEO Humayun Chaudhry, the organization urged swift passage of the Interstate Medical Licensure Compact, which would simplify multi-state licensing and improve healthcare access, especially in rural and underserved communities. FSMB also asked the President to remove barriers to telehealth services, including those provided to military personnel and veterans.

President Trump has pledged to improve Veterans Affairs services, but he can’t fault the VA for its policy on medical licensure. The department already allows physicians to work in any of their facilities, even if they’re licensed in just a single state.

Mr. Trump has vowed to eliminate unnecessary regulations – and many would argue that state-by-state medical licensure falls into that category. If a New York physician wants to get licensed in nearby New Jersey and Connecticut, she must provide much of the same information and pay a hefty fee and yearly renewal for each application.

This places a special burden on Alaska and Hawaii – states that don’t share a border and are geographically distant. Patients in these states are often forced to fly to the lower 48 for care because many specialists feel it’s pointless to get licensure when their practices are thousands of miles away.

We’ve all heard about the organization Doctors Without Borders who provide free medical care around the globe. In the U.S., we urgently need doctors without state borders. National licensure would make doctors’ lives easier by eliminating red tape and expenses – and would improve patient care by making telehealth transparent nationwide.

Simplifying PTSD Treatment with Telehealth

Veterans with Post-Traumatic Stress Disorder (PTSD) are now receiving telehealth treatment that’s every bit as effective as in-person visits. It’s an encouraging alternative for veterans who otherwise would have to drive to a Veterans Affairs (VA) clinic for up to 15 weekly sessions.

In a recent six-month study highlighted in Behavior Research and Therapy, 66 veterans were treated at VA clinics while the other 66 were treated remotely using telehealth technology. All the participants were assessed using standard PTSD scales that measure symptom severity and depression.

During the six-month trial, each participant received up to 12 prolonged exposure therapy sessions – lengthy encounters that help the patient confront memories and situations that trigger PTSD symptoms.

Head researcher Ron Acierno told Reuters Health that “our effects with PTSD were just as good with home-based telehealth as with in-person treatment.” Telehealth is also being used to connect recovered PTSD patients with those receiving prolonged exposure therapy. “We’ve had tremendous response combining home telehealth with peer support during exposure,” added Acierno.

The study revealed that telehealth therapy takes time to reach full effectiveness. The at-home treatment scores for depression were not as good as in-person scores at the three-month mark, but reached parity by six months.

Acierno feels that telehealth treatment is ideal for PTSD patients who can’t afford to take time off work, or want to avoid the stigma of being seen at a VA clinic. “With telehealth, we can now save the travel time and bring the treatment right to them.”

Telehealth Industry is “Exploding”

When you hear about a successful venture that’s “exploding” or “overwhelming”, it usually brings to mind a blockbuster movie like 2015’s Star Wars: The Force Awakens, which has grossed nearly $2.1 billion since its release.

Now you can officially add “telehealth” to the list.

American Telemedicine Association CEO, Jonathan Linkous, recently told Healthcare IT News that “telehealth is an exploding field…it’s almost overwhelming.” And his view is validated by new research from MarketDataForecast.com, which predicts the telehealth industry will more than double in a five-year period – from an estimated $25 billion industry in 2015 to nearly $58 billion by 2020. That type of spectacular growth makes Star Wars: The Force Awakens look tame.

The ATA’s Telehealth 2.0 conference in April is on track to showcase more than 1,000 new telehealth products and technologies. But all this innovation brings its own set of challenges. And what Linkous calls the #1 challenge – going beyond hospital walls to provide seamless integration across the care continuum – is an area where InTouch Health is already offering solutions.

We knew that telehealth was poised for explosive growth…and we’re ready to meet the challenge.

Telehealth Safeguards Newborns

Some precious lives start out in jeopardy, like the 10% of newborns with an Apgar respiration score of one (irregular breathing) or zero (no breathing at all). Most of these babies can be resuscitated easily, even in a small community hospital, but about one case in a thousand requires advanced intervention that only a highly trained neonatologist can provide.

Telehealth is helping deliver that expertise, as documented recently in Mayo Clinic Proceedings. For twenty months, Mayo’s division of neonatal medicine worked with six health systems to provide 84 newborn consultations using telehealth technology.

Dr. Jennifer Fang, a fellow in Mayo’s neonatal program, said, “Following a complicated delivery, a newborn’s outcome is associated with the quality of care provided during the first minutes of life. In Mayo’s telehealth study, the enhanced access to neonatologists – who could guide the local care team through the resuscitation – allowed one-third of the babies to stay with their families in the local hospital.”

Providers at the community hospitals gave the telehealth consultations high scores for clinical teamwork and quality of care. “These results speak to the acceptability and clinical impact of this type of telehealth project in community hospitals,” added Fang.

We’ll never know how many of these small town, one-in-a-thousand babies will grow up to become adults who change our world. But now newborns around the globe – in both rural and underserved urban locations – can get a better start thanks to telehealth. And their parents can breathe a little easier, too.

Machine Learning Meets Telehealth

The synergy between machine learning and telehealth will soon make the futuristic medicine practiced in the hit movie Doctor Strange seem like child’s play.

IBM Watson Health is leading the revolution in so-called “cognitive computing,” where machines develop the ability to make inferences and discoveries. For example, the Watson supercomputer can “read” 200 million pages of text in three seconds, then draw conclusions from what it analyzed. If there’s a medical journal in Singapore that provides the missing link to research in San Francisco, IBM Watson can find it. That’s a much-needed skill, since there are now an estimated 150 exabytes of healthcare data in the world. (That’s 150 billion gigabytes.)

In an article published recently in The Guardian, InTouch founder and chairman Dr. Yulun Wang notes that “artificial intelligence, such as machine learning, will soon be integrated cohesively into healthcare delivery through telehealth so that big data sets can be gathered and analyzed to improve global care. It will also improve individual care by matching the specifics of a patient’s diagnosis and treatment plan to millions of comparable cases.” Dr. Wang went on to predict that by 2050 most healthcare will be delivered virtually – and will be as commonplace as online banking is today.

That’s a realistic forecast, considering that IBM Watson researchers are now thinking in terms of “zettabytes” of data. A zettabyte is 270 – a number that’s hard to get your head around. One zettabyte of data would fill a stack of DVDs that would literally stretch from Earth to Mars.

Thanks to advances in machine learning and processing power, it won’t be long before exam rooms become “smart spaces” where every word spoken in a telehealth encounter gets entered as text in a patient’s chart in real time. There may even come a day when Watson is the telehealth neurologist providing remote guidance to human clinicians.

Telehealth Enters The Mainstream

We’ve all heard the term “mainstream media,” which differentiates network TV and the New York Times from, say, blogs intended for a niche audience. We often view healthcare in the same way, where primary care and acute care are the “mainstream,” leaving things like concierge medicine and palliative care on the margins.

For too long, telehealth has been relegated to the margins. Now it’s time to quit viewing telehealth as a boutique service for sophisticated consumers. In other words, it’s time to treat telehealth as just “health” – no different from any other form of medicine.

InTouch Health founder, Dr. Yulun Wang, has long emphasized that telehealth plays a critical role at every point in the care continuum. Just look at the continuum diagram above and you’ll see that telehealth is involved at every “mainstream” point possible – from intensive care to ambulatory surgery centers to rehab facilities, long-term care, pharmacies, and even the patient’s home.

That’s why it’s strange that some people still see telehealth as a niche service, useful only for someone who has a stroke while fly-fishing in some rural stretch of Montana. But the truth is that telehealth is becoming commonplace and ubiquitous, improving outcomes in inner-city clinics, urgent care offices, operating rooms, skilled nursing facilities, and a host of other places.

That’s about as mainstream as you can get. So maybe some day we’ll drop the “tele” entirely and start simply calling it “health” – safeguarded at every step by seamless technology.

Assessing Telehealth’s Value

A typical value-based care contract (VBC) is extremely complicated, but gauging the overall value something brings is much easier – and telehealth delivers amazing value.

Recently, at the American Association of Nurse Practitioners’ Specialty & Leadership Conference, family nurse practitioner Thanh Nguyen from Providence Health Express in Oregon noted that “we don’t know” what telehealth’s return on investment will be in the new value-based care model. Only about 40% of providers are even using VBC contracts, which means that six out of 10 providers are still using the fee-for-service approach.

But Nguyen is certain about one thing: telehealth is providing undeniable value every day. In her view, it’s saving lives and improving access to care while offering growth opportunities for nurse practitioners.

Nguyen feels that it’s now time for legislators and regulators to bring more telehealth value to clinicians – namely, getting paid for every hour worked.

In a recent speech, the American Medical Association’s immediate past president, Dr. Steven Stack, spoke about the need for a “quadruple aim”: adding “clinician satisfaction” to the current trio of improved access, better care and lower costs. “We need to restore joy to the practice of medicine,” he said – one way to do that is fair compensation for the long hours worked.

Current reimbursement policies don’t allow telehealth providers, like Nguyen, to get paid a penny for the time it takes to respond to patients’ emails. She’s licensed to practice only in Oregon and Washington, and she recently got burned by a Nevada patient who claimed to be visiting friends in Oregon. Ultimately, Nguyen had to waive her fee for the 20-minute session.

The healthcare industry’s journey to value-based care is a worthy effort, but it will only succeed when it brings real value to the clinicians who make it happen – and when it fairly compensates them for the care they provide via telehealth technology.

Survey Reveals Positive Views For Telehealth, Part II

From Ross Perot to the fictional J.R. Ewing from Dallas, business people rule the roost in Texas. And their powerful voices are providing strong tailwinds for telehealth in the Lone Star state.

The Texas Association of Business (TAB) recently published a report called “Telemedicine: The 21st Century Answer To The Call For Better Healthcare.” In our previous blog, we discussed why patients across Texas are pumped about the prospects for telehealth. Now let’s take a look at what influential business leaders are saying:

  • A Texas-size 77% favor using telehealth to diagnose common medical conditions.
  • 70% feel that access to providers has gotten more difficult in recent years.
  • 18% of Texas companies surveyed already offer telehealth as part of their health benefit programs.
  • Of that 18%, a unanimous 100% of the companies plan to continue offering telehealth benefits – and 24% plan to expand their current programs.
  • 66% received positive feedback on telehealth from their employees – and not a single employer received negative feedback.

States like Texas, California and New York are early adopters who greatly influence initiatives in the other 47 states. It’s not surprising that those three states have already passed telehealth parity laws, encouraging holdout states like Utah and Wisconsin to join their ranks.

When the Texas business community wants something, they get it – usually without delay and they’re demanding a wider use of telehealth technology. Why would J.R. Ewing drive from Dallas to Ft. Worth to see a specialist when telehealth is available?

Survey Reveals Positive Views For Telehealth, Part I

Texas has long been a bellwether state, just like California and New York. All three of those states have large cities plus sizable rural stretches. Think Houston/Amarillo, L.A./Modesto, New York City/Syracuse.

That’s why the new Texas Association of Business (TAB) report on telemedicine is so encouraging. Entitled “Telemedicine: The 21st Century Answer To The Call For Better Healthcare,” it provides ample proof that states with both megacities and wide open spaces are fertile ground for telehealth.

The report contains so much good news that we’re devoting two blogs to what it highlights: first from the patient perspective, then from the employer angle.

The report begins with a sobering overview of the current state of Texas healthcare, where physician shortages, rising healthcare costs and poor patient outcomes have become the norm. The report estimates that one-third of medical issues now resolved in doctors’ offices, urgent care clinics or EDs could be handled effectively via telehealth.

TAB surveyed 600 registered Texas voters to get their opinions on telehealth, and their answers may surprise you:

  • 70% of those surveyed favor the use of telehealth to diagnose common medical conditions.
  • 51% of those Texans feel that access to providers has grown more difficult in recent years.
  • 24% of rural Texans surveyed have to drive 30 minutes or more to visit a doctor’s office.
  • 23% of those surveyed have to wait 14 days or more to see their doctor.

The TAB survey shows that Texas patients are clamoring for fresh solutions like telehealth. To use a popular expression in the Lone Star state, they’re “chompin’ at the bit” for change.

In the next blog, we’ll discuss why Texas employers are equally excited about what telehealth can deliver.