The Latest in Remote Presence.

As health reform was being debated, many people theorized that hospital volumes would begin to drop as care was delivered at other points along the continuum. Well, it’s not a theory anymore. In fact, the numbers are a bit startling.

Health Management Associates (HMA) and Hospital Corporation of America (HCA), two of the nation’s biggest for-profit hospital chains, just reported big drops in first quarter admissions compared to the same period last year. At HMA, same-facility admissions fell by 8.8 percent. Across the country, both hospital admissions (and readmissions within 30 days) are steadily trending downward

Telemedicine is playing a key role in driving down hospital admissions. A remote stroke specialist can now examine patients in any robot-equipped ED, outpatient facility or ACO clinic. Telemedicine is also the ideal platform for ongoing patient monitoring that prevents unnecessary admissions in the first place – plus preventable readmissions that are now accompanied by hefty fines.

We’re just beginning to realize telemedicine’s true potential in disease prevention. It doesn’t take a genius to understand that a 340-pound patient who doesn’t exercise or make regular primary care visits is a prime candidate for a stroke or heart attack. Telehealth e-visits and follow-ups can go a long way toward eliminating the need for remote stroke consultations down the road.

Though volumes are decreasing, hospitals are still the primary funding resource for telemedicine initiatives across the entire care delivery system. Hospitals will still be the healthcare “hub” of the future because of their on-staff expertise and big IT budgets. But they’re likely to get a little quieter as expert care gets delivered in a variety of new settings.

Because of health reform, the U.S. healthcare system is bracing for the overnight influx of an estimated 20 million or more newly insured patients on Jan. 1, 2014. Balancing supply and demand will be tricky because as millions clamor for health services, there will be an estimated 200,000 fewer physicians nationwide to provide them. That’s why so many people are counting on telemedicine to be the Great Equalizer.

Here’s the demographic challenge: most of the fastest growing states in the U.S. are in the northern plains, an area that isn’t exactly a doctor magnet. (North Dakota is our fastest growing state because of the Bakken shale oil fields.) Meanwhile, populations in some eastern states like Rhode Island and Michigan are actually declining. With telemedicine, physicians who might be twiddling their thumbs in Providence and Kalamazoo can help care for some of those drillers in the Dakotas.

A report by the U.S. Census Bureau has revealed the top 10 states that have seen a population boom in 2012, seen in red, along with the worst, seen in blue.

States in the western U.S. and New England are the most “Obamacare-ready,” so they’re likely to see the biggest surge in demand. They could get help, however, from doctors in the 16 states that currently oppose Medicaid expansion (and probably won’t experience an immediate avalanche of new patients).

As Nirav Desai noted in a recent Hands On Telehealth post, matching healthcare supply and demand will depend in large measure on how well we utilize nurse practitioners and physician assistants. According to the Agency for Healthcare Research and Quality, there are about 56,000 NPs and 30,000 PAs practicing in the U.S. As Nirav points out, telemedicine could connect these mid-level practitioners with a physician in a central location. They could examine most patients on their own, and consult with the physician on more complicated diagnoses.

No other industry has ever faced a more daunting task than what awaits the healthcare field next year. If you sell tires or toothpaste, no one has ever thrown a switch and handed you 20 million new customers instantly. But telemedicine gives our overtaxed healthcare system a decent chance of being able to connect practitioners with patients, from Pawtucket, Rhode Island to the boom towns of North Dakota.

By fostering greater hospital partnership, the Affordable Care Act is already showing early signs of success. CMS notes that the national percentage of 30-day hospital readmissions – which was stubbornly stuck at

Health reform is providing both carrot and stick to make collaborative healthcare a reality.

19% for years – is finally starting to come down.  It’s now at 17.8%, and health reform and telemedicine deserve a lot of the credit.

Some telemedicine-based programs are getting far better results than the national average. For example, Geisinger Health Plan has implemented a telehealth program that has already cut hospital readmissions by a whopping 44%.

Obviously, the more collaboration between healthcare organizations, the better the results. Spurred by health reform, nearly 60% of hospitals are now part of a broader system. The ACA funded one of the most successful so far: 26 “Hospital Engagement Networks” (HENs) that work with more than 3,700 hospitals to coordinate patient care. According to the Advisory Board Company, the largest of the HENs has reduced its average 30-day readmission rate across 450 hospitals from 11.2% in 2010 to 10.2% by late 2012. That’s encouraging news for the folks in the Big Henhouse at 1600 Pennsylvania Avenue.

Last October, CMS began fining more than 2,000 hospitals with high readmission rates, imposing the maximum penalty of 1% in reduced Medicare reimbursements for 300 of them through the remainder of this year.

There are, of course, other factors driving hospitals to join larger systems: increasing margin pressures, plus the need to find economies of scale to improve care quality. But it’s clear that health reform is providing both carrots and sticks to make collaborative healthcare a reality.

If health reform and telemedicine continue to boost quality and rein in costs, it will be a nightmare for legislators who opposed them. Their biggest fear was that these things would actually work – and that people would love them so much that there would be no turning back.

As more success stories like these come rolling in, the president may soon be proud to call his program “Obamacare.”

Health reform has given us a lot of buzzwords like “accountable care” and the warm-and-fuzzy “medical home.” They try to capture the essence of where reform is taking us: to a patient-centered system where collaborative care provides higher quality, better outcomes and lower costs. By tearing down silos and eliminating redundant tests, everybody wins.

That’s the grand vision anyway. But many healthcare organizations are having a tough time making the transition to this new approach.

To see how collaborative care is supposed to work, just look at the new telestroke program at the University of Cincinnati Neuroscience Institute and University Hospital. This teaching facility has long been in the top 25 of America’s academic medical centers – and the UC Stroke Team was started way back in 1987.

The new telestroke program is powered by ITH’s Remote Presence technology, connecting UC stroke specialists with physicians at UC Health’s West Chester Hospital and Dearborn County Hospital (just across the state line in Lawrenceburg, Indiana).

Here’s how the telestroke program meets the “triple aim” of health reform:

Higher quality care – Patients are quickly examined by a stroke specialist who can see and hear them right at the bedside.

Better outcomes – The program will save more lives – and provide higher quality of life – thanks to faster intervention and greater teamwork.

Lower costs – With Remote Presence, only the most severe stroke cases need to be transported to expensive tertiary centers – and many more patients can remain in facilities close to home.

“This is an important advance for us, and more importantly, for our patients,” says Dr. Opeolu Adeoye, director of the UC telestroke program. “This will allow them to stay closer to home at partner hospitals while still receiving the most advanced care available.”

Those words are almost like a mission statement for health reform. In the old paradigm, there would have been a number of time-squandering steps: local triage, transport to a stroke center, repeat diagnoses. But with telemedicine, the ED doctor, specialist and patient are all communicating in real-time.

Telemedicine is helping providers reach consensus in minutes, not hours. That’s what industry pundits call “collaborative care” – and what stroke survivors call a “miracle.”