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No Crystal Ball Needed

For far too long, telehealth has been touted as a future miracle that’s just out of reach. So it’s significant that the theme of a recent U.S. News Hospital of Tomorrow conference was “Telehealth Isn’t The Future – It’s Changing Care Now.”

From beginning to end, the conference highlighted what telehealth is doing in the present: improving care, lowering costs, reducing hospital readmissions and much more.

You don’t need to be H.G. Wells to realize that most Americans are perfectly comfortable getting technology-enabled remote medical treatment. But what is surprising is the scope of what’s already being done nationwide. For example, you don’t automatically think of ophthalmology as a prime candidate for telehealth. But conference speaker Dr. Julia Haller chronicled how Wills Eye Hospital in Philadelphia is using remote home monitoring for patients at the highest risk for the progression of blindness.

Another present-day achievement is how telehealth is transforming the rules of engagement. It’s knocking down the barriers that have long existed between doctor and patient. At the conference, University of Pittsburgh Medical Center telemedicine director Dr. Andrew Watson discussed how today’s patient portals are bringing new spontaneity to physician-patient communication – something not seen since the heyday of house calls.

The recent Disney movie Tomorrowland was only modestly successful at the box office. Maybe what we really need is a movie called Present World – one that celebrates what telehealth is achieving in the here-and-now.

 

Telehealth

Telehealth Today

 

 

 

 

 

Care Coordination, VA-Style

The Department of Veterans Affairs has taken a lot of heat lately, but one thing they’ve done right is to be an early and enthusiastic advocate for telehealth.

Veterans with traumatic brain injuries require care coordination that goes above and beyond. The VA starting using telehealth technology in 2003 to foster greater communication between the veteran’s family members, clinicians and rehab providers.

Here are some lessons we’ve learned from the VA’s head start in telehealth:

  • Be decisive – There’s nothing wishy-washy about the military. Once the VA saw the potential in telehealth, the organization jumped in with gusto. That’s the polar opposite of how Accountable Care Organizations (ACOs) have implemented telehealth. The eHealth Initiative found that just 23 percent of ACOs surveyed were actively using telehealth technology. That’s partly because Medicare’s Pioneer ACO model didn’t initially contain enough telehealth incentives. CMS is trying to remedy that in its soon-to-launch Next Generation ACO model. But so far, ACOs haven’t come roaring out of the telehealth gate like the VA did.
  • Have a vision – When the VA began using telehealth twelve years ago, its stated aim was to “improve the health of designated individuals and populations with the intent of providing the right care in the right place at the right time.”

That last phrase has since become the mantra of telehealth: right care, right place, right time. The VA had a vision for what telehealth could provide – and now it’s a reality around the world.

The VA is the poster child for what it means to be an “early adopter” of telehealth technology for care coordination. Now it’s time for CMS and other influential healthcare organizations to likewise have a dream for what telehealth can accomplish — and to move confidently in that direction.

Veterans Affairs

Telehealth Veterans Affairs

 

 

 

 

When Demand Explodes

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.

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.

Wisdom Shortage Creates Doctor Shortage

We’ve all seen Clint Eastwood westerns where the sheriff says, “We can’t treat him here…the closest doctor is in Dodge City.”

Without telemedicine, that’s the future we’re all facing. In little more than a year, some 30 million new patients will enter the U.S. healthcare system – the equivalent of every man, woman and child inVenezuela. Meanwhile, the Association of American Medical Colleges (AAMC) predicts that the physician shortage in America will reach 130,000 by 2025.

Legislative caps on residency funding will only worsen the current physician shortage.

One of the main reasons for the shortage is that the federal government has capped its funding for doctor residencies. Because there are so many deficit hawks in Congress now, it’s unlikely that the cap will be increased anytime soon – and efforts at private funding have stalled. You know we’re in trouble when a Congressman named “Price” (Tom Price, R-Ga.) bemoans the price of training physicians, but can’t muster the votes to change things.

Atul Grover, the AAMC’s chief public policy officer, recently said that “we’re going to have to find ways to see more patients with fewer physicians” to handle the increased volume.

And that’s exactly what telemedicine is doing. While politicians dither and medical schools stay in no-growth mode, telemedicine is enabling the doctors we do have to extend their reach. In fact, telemedicine solves one of today’s thorniest problems: the need for doctor relocation. These days, a young doctor can improve the quality of care in rural communities without ever leavingPhiladelphia or San Francisco.

Like a storm blowing through a western town in that Clint Eastwood movie, there’s a perfect storm on the horizon: millions of new patients, not enough doctors. That storm may be strong enough to blow away all remaining barriers to telemedicine.