Unless you’ve been hiding in a cave or buried your head in the sand recently, you have probably heard a little about telemedicine or telehealth. The good news is, even if you’re a little late to the party, there’s still time to get in on all the excitement. The future is bright and most experts agree that we are still in the early stages of what is one of the fastest-growing segments of healthcare. Let’s take a few moments to get caught up.
What is telemedicine/telehealth?
There are many definitions of telemedicine and telehealth. Some of those definitions try to distinguish between telemedicine and telehealth. Most of these definitions stem from regulatory and reimbursement issues. However, the American Telemedicine Association (ATA) defines telemedicine as, “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.” Whether it’s simple every day technology such as telephone, text messaging, video and email or technologically advanced monitoring devices, distant site learning, or remote patient monitoring, the terms telehealth and telemedicine are often used interchangeably.
Where is telemedicine being implemented?
Even though telemedicine is still in its infancy, it is starting to be deployed everywhere you turn. Healthcare organizations, governmental agencies, retail pharmacies, insurers and independent private companies are starting to tap into the power of telemedicine. Some of the oldest forms of telemedicine have been around for decades yet you may have never even realized that they were practicing telemedicine. Poison control centers perform millions of consultations every year via a simple phone telemedicine consultation with patients and providers across the globe. Healthcare organizations using radiologists at distant sites or even at home, interpret radiologic studies via telemedicine. And let’s not forget our military who has deployed telemedicine for years on the battlefield and beyond.
Over the past 5-10 years as telemedicine has been gaining most of its momentum, private telemedicine organizations have controlled the majority of the market. These organizations such as Teledoc, MDlive, SwiftMD and a whole host of others have been primarily performing urgent care visits for employers who are looking for an employee benefit to try and reduce some of their healthcare costs. They typically have a business organization and an associated medical practice with a network of hundreds to thousands of doctors across the country treating simple urgent care care complaints.
Even with this narrow scope of practice, these organizations have seen significant growth. While most of the biggest successes have been in this arena so far, this has spurred a new wave of telemedicine growth that will go far beyond the simple handful of conditions that most of these organizations treat. Insurance companies such as Cigna, United Health, and Aetna have begun to deploy telemedicine as well with the hope that they can keep simple conditions out of emergency rooms and urgent cares which are much more costly options. Retail pharmacy chains such as CVS and Walgreens are now offering telemedicine.
The latest trend, which may ultimately be the final piece to the telemedicine puzzle that turns it from a niche to the mainstream medicine market, is hospital systems and practices are beginning to provide telemedicine services to their patients. These hospital systems and practices had initially started to provide telemedicine services in response to the competition. They are realizing that if they don’t provide telemedicine services for their patients, they will seek it elsewhere. This could result in a loss of market share as well as fragmenting care. Now the move toward valued based payments are only fueling the telemedicine fire. These health systems and practices will be rewarded for providing quality and efficient care. Telemedicine provides them a unique opportunity to provide affordable, high quality and efficient care.
Why is telemedicine one of the fastest-growing segments of healthcare?
The rapid growth of telemedicine is related to a number of reasons that are creating the perfect environment for it to thrive. Problems such as a massive primary care physician shortage, healthcare cost spiraling out of control, the affordable care act bringing millions of newly insured to the market, high patient satisfaction, and the rise of consumerism are some of the biggest reasons for the growth. It’s yet to be determined which one of these factors will be the biggest driver of telemedicine growth in 2016 but it’s safe to say they are all playing a role.
What are some of the challenges that telemedicine is facing?
There are a few challenges that telemedicine is still facing. These include regulatory and reimbursement, state licensure, and safety and security. The current legal environment right now is still somewhat of an issue because the laws have not caught up with current practice in some states. There is also the fact that every state as well as federal regulations differ in even the definition of telemedicine as we discussed. The laws differ from state to state in who can practice telemedicine and how it is to be practiced. Licensure is a current barrier for some practices because every provider must be licensed in the state that they practice. Patients who need telemedicine don’t always fall along strict state lines and therefore providers who want to practice telemedicine often need to be licensed in multiple states. Currently, each state controls the process and it can often be timely and expensive for providers to get licensed in multiple states. There is a new legislation pending that may potentially help this issue. However, until this is completely resolved it remains somewhat of a barrier for certain organizations. Reimbursement, while improving, is still a barrier. As we discussed, insurers are starting to come on board but it’s still inconsistent and yet to be determined what the correct model of reimbursement will be. The fee-for-service model that they have initially rolled out for telemedicine has not yielded the success some had hoped. However, as we move into a new era of reimbursement, telemedicine will play an integral part in providing lower cost, more efficient care. Finally, with new technology comes new security risks. HIPAA laws must be strictly adhered to. Transmitting and storing medical information using new technologies can lead to challenges that organizations must overcome.
When we look into the future, what will we see with regard to telemedicine?
It wasn’t that long ago when people thought they would never trust any information that they get on the Internet, yet now it’s where we get most of our information. It wasn’t that long ago when people said I’m not going to shop online, yet now most people couldn’t imagine not shopping online. Do you remember when banking was only done at the brick and mortar locations? Now most people bank online. Healthcare will follow suit. In the very near future most people will be saying, remember when we used to have to go to the doctors office for many of the things that we simply click on our app for today? The reality is, the future of telemedicine is upon us.
About the author: Keith Algozzine is a board certified Physician Assistant who has been practicing medicine for over a decade. It was his love for sports that originally attracted him to medicine. After undergraduate work at SUNY Cortland, graduating with honors and earning a B.S. in Sports Medicine and Athletic Training, Keith completed his graduate training as a PA at Springfield College and Baystate Medical Center. Throughout his career he has worked in the capital region in family medicine, telemedicine and emergency medicine. He has been the Chief PA of Emergency Medicine of a local emergency department as well as a founding member and Director of Patient Services for a nationwide telemedicine company, Upstate Concierge Medicine & Management.
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