Saving U.S. Health Care With Skype

Lawmakers and proponents of telemedicine have begun exploring how technology can improve the health care system in the wake of Obamacare

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The University of Virginia Health System is home to a program that may be essential to solving the health-care-access problem in the U.S. The program is centered around telemedicine, or the use of electronic communication to exchange medical information either from patient to physician or between doctors.

Through the UVA system’s Center for Telehealth, physicians from 40 specialties partner with 108 community hospitals, free clinics, schools and more to provide nearly 33,000 people with care they otherwise wouldn’t be able to acquire.

“It saves lives, it saves functions, and it reduces cost,” David C. Gordon, the director of the office of telemedicine and rural network development at UVA Center for Telehealth, says about the program.

According to Gordon, the University of Virginia Health System has reduced preterm deliveries during high-risk pregnancies by 25% via telemedical services that maintain communication between patients and physicians through technology as simple as Skype and as complicated as robotics, even when those in need are hundreds of miles away from care.

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Since its inception, Gordon says, they have saved Virginians over 7.9 million miles in travel for health care.

The UVA system, however, is not alone in providing a once unavailable service to patients; every state has a telemedicine program, ranging from stroke diagnosis to psychiatric evaluations to prenatal care. And now, with the expanding insurance coverage provided by the Affordable Care Act — and the doctor shortage predicted to come with it — proponents of telehealth believe its widespread implementation can have a positive impact on the future of the health care system.

“There is this perfect storm of increased demand with the newly insured, a shortage of primary-care physicians and specialists, and a need to keep costs in control,” Mario Gutierrez, the executive director of the Center for Connected Health Policy, a leading telehealth policy center, tells TIME. “I think telehealth provides a real vehicle for doing that.”

If members of health care communities with and without specialists and highly skilled practitioners are able to work together using technology, Gutierrez says, the issue of access to care can be met head-on. “What the system will encourage is for the greatest efficiency and improvements in quality that are going to be measured by the outcomes of the patient population,” he says.

Some outcomes have already begun to prove there is some benefit in adopting telemedicine: the Partners HealthCare system in Boston was able to reduce readmission of 1,200 heart-failure patients by 50% through a home telemonitoring program. Under the Affordable Care Act, Medicare is required to reduce payments to hospitals that have excessive readmissions rates by as much as 2% in 2014. New advancements in telemedicine such as in-home care products, proponents say, allow doctors to follow up with patients from outside the hospital via a computer or mobile device, which can help hospitals reduce readmission rates and avoid penalties.

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Other technologies, like WellPoint’s LiveHealth Online, cut out the initial visit altogether, letting patients visit the doctor from home or work via live video and instant-messaging services with doctors. That is something that could be of great use in the coming years, with the Association of American Medical Colleges estimating that the U.S. will be doctor-deficient by as many as 91,500 by 2020.

The benefits of telemedicine were also the topic of discussion at a briefing on Capitol Hill on Friday, where panelists from both the private and public sectors declared everyone is a winner when telemedicine is implemented. “It’s a win-win,” said Neal Neuberger, the executive director of the Institute for e-Health Policy, on Friday. “I’ve never met a member of Congress on either side of the aisle, in either house, that didn’t think this was a good idea.”

Though Congressman Gregg Harper, a Republican from Mississippi, is presenting a bipartisan bill to Congress this week that tackles the cost of telemedicine and expands the role of Medicare and Medicaid, telehealth still faces huge barriers to widespread implementation, largely because of the fact that there is no comprehensive standard policy surrounding it. “The march of technology for health care far exceeds our ability to adopt, diffuse, incorporate and govern … in a public- and private-sector setting, any of these technologies,” says Neuberger.

Because of licensing rules, physicians are generally unable to practice outside their states. If a patient they’re seeking to provide virtual care for is out of state, they will need a license in both places, restricting access for those in need. Medical boards have also placed higher regulatory standards on telehealth practices, like a requirement that a patient mush have an in-person, established relationship with the provider before receiving care.

Doctors are also limited in the services they are reimbursed for under Medicare, which only encompasses telehealth services that are provided in narrow scope of rural areas, by physicians and nurse practitioners in specific offices. According to the American Telemedicine Association, 80% of Medicare beneficiaries are not covered because they live in counties federally designated as metropolitan areas. Despite that, 42 states cover telehealth through the Medicaid program, and 15 states have laws that mandate coverage for telehealth services.

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1 comments
kdrude
kdrude

20 states and the District of Columbia now mandate that private insurance plans cover telehealth services.

Kenneth P. Drude, Ph.D.