Mainstreaming Telemedicine

Earlier this month I had a conversation with Gary Capistrant, senior director, public policy, American Telemedicine Association, and he brought up a really interesting point relating military servicemembers and telehealth, and it got me thinking what really needs to happen to get more widespread adoption of  telemedicine. Gary and I were discussing what’s important for CIOs, CTOs, and CMIOs when they’re purchasing telemedicine hardware (for more on that, stay tuned for my July feature), and he mentioned how servicemembers, who are increasingly using Skype and other Internet calling services to speak to their family and friends while deployed, are also expecting to use those same technologies to serve their healthcare needs when they return stateside.“The VA and DoD are under a lot of pressure to use telehealth because the soldiers coming back have been using Skype for a long time talking to spouses and kids; and they say, ‘wait a minute, I don’t want to drive three hours to my doctor or psychologist for a short visit that can be done on Skype,’” Capistrant told me.The VA has been using online screening for years to perform mental-health screenings, and in 2009 the VA started an Internet-based chat line for servicemembers to discuss stress. Those in the military have viewed consumer-based technology as increasingly important to reach servicemembers, not only because they’re comfortable with, but because those not on active duty are widely dispersed and sometimes hard to reach.I’ve been reporting a lot on telemedicine recently, investigating HEALTHeLINK, the Buffalo-based Beacon Community, which has had early successes with its diabetes telemonitoring pilot that identifies high-risk patients through mobile monitoring before they are hospitalized, and the Arkansas START program that offers telecolposcopy through rural clinics, so thousands of women don’t have to either delay or go without important gynecological treatment. Telemedicine projects like these are contributing to a growing telehospital/clinic market, which was worth $8.1 billion in 2011 and is expected to grow to $17.6 billion in 2016, according to BCC Research (Wellesley, Mass.).  What gives me the most hope for those of us civilians who live in urban settings (me included) is the UPMC eVisit program that was a semifinalist in our Innovator Awards program, and that I’ll be reporting on next week. In short, the eVisit platform allows non-emergent patients to seek treatment for things like back pain, bronchitis, burn, cold symptoms, and other problems, by completing a tailored questionnaire to provide the physician with medically relevant data in structured form. After submission of the questionnaire, patients receive responses from their physician, typically within four hours and sometimes within minutes; and physicians are staffed to respond to eVisits through extended daytime hours, with many physicians responding outside of regular hours as well.But what is really holding these programs back is that age old problem—money. That’s definitely the case with UPMC, said G. Daniel Martich, M.D., CMIO, UPMC. “While [CMS] embraces the idea of an eVisit by creating a CPT code for [telehealth], that’s 99444, they don’t have any reimbursement for that yet,” said Martich. “I think they are concerned that, ‘if we start making this one of the benefits to all of our membership, we may see a huge increase in this, without a huge decrement in emergency or doctors visits, and this is going to cost us more money.’” Dr. Martich says that CMS and other insurers are waiting for studies, like the one he and his UPMC colleagues are currently working on, to evaluate the cost, follow-up care, and efficacy of treatment for office visits versus eVisits.Here’s to hoping those studies blow CMS and other hesitant insurers out of the water with proof that the eVisit could be financially feasible, as well as convenient pathways to care for patients.