According to researchers at InMedicine, utilization of telemedicine is expected to grow significantly in the next few years, led by the growth of remote patient monitoring. Specifically, remote patient monitoring is expected to be used with 1.8 million patients by 2017, compared to just over 300,000 today. That’s six-fold growth in only four years.
The main reason for the projected growth in telemedicine is money. Medicare and Medicaid are adopting readmission penalties, and this is driving the adoption of telemedicine as a means of avoiding readmitting patients to hospitals. The American Medical Association (AMA) favors the expansion of telemedicine, saying it could significantly improve access to and quality of care. The AMA endorsed the use of remote monitoring and interactive physician services during its Annual Meeting in June.
Telemedicine and the AMA’s Strategic Focus
In Report 7 of the Council on Medical Service discussing coverage and payment for telemedicine, the AMA states that telemedicine is “a key innovation in support of health care delivery reform,” and is already improving access to care, as well as coordination and quality of care. It also shows great promise in reducing the rate of growth in healthcare spending.
The AMA has three strategic focus areas:
- Improving health outcomes
- Accelerating change in medical education
- Enhancing physician satisfaction and practice sustainability
Report 7 states that the evolution of telemedicine affects all three of the AMA’s areas of strategic focus. The AMA divides telemedicine into three basic categories:
- Store and forward telemedicine
- Remote monitoring
- Interactive telemedicine
Store and Forward Telemedicine
So-called “store and forward” telemedicine is perhaps the simplest type of telemedicine. It involves transmitting medical data like medical images or medical records to physicians or medical specialists for assessment. The patient and physician don’t have to be present at the same time, so the logistics of this type of telemedicine are simpler. As a result, store and forward telemedicine has become popular in specialties like radiology, pathology, and dermatology, which are types of medicine where asynchronicity makes sense and doesn’t generally affect patient outcome.
Remote monitoring is more complex than store and forward telemedicine. With remote monitoring, patients are monitored remotely with various types of technological devices. Remote monitoring is helpful in management of chronic diseases like heart disease and diabetes, or with conditions like asthma. Remote monitoring allows patients to capture health status indicators like blood pressure, glucose levels, weight, and even ECG information at home, without going to a clinic or hospital.
Interactive telemedicine is the most complex and advanced type of telemedicine, and it relies on broadband telecommunications technology. Interactive telemedicine provides real-time interaction between a patient and healthcare provider using audio or video technology. Interactive telemedicine has been used instead of traditional care delivery in an office or clinic setting. It can be used in diagnosis, consultation, treatment, education, care management, and patient self-management situations. In general, audio and / or video communications technology is required for third party payers to agree to coverage of interactive telemedicine visits.Medicare and Telemedicine
Medicare pays around $6 million every year for telemedicine services, and provides payments to physicians and other healthcare professionals for a prescribed list of Medicare Part B services. Some of these services are: initial and follow-up inpatient consults, office and other outpatient visits, psychiatric diagnostic interviews, services related to end-stage renal disease, and lifestyle therapy for addressing cardiovascular disease.
Currently, the sites where Medicare beneficiaries receive telemedicine services are limited to areas considered as rural Health Professional Shortage Areas, but the number of locations that qualify may increase due to a recent change in Medicare’s definition of Health Professional Shortage Area.
Telemedicine services covered by Medicare must have both interactive audio and video along with real-time telecommunication. Healthcare providers code billing with special payment modifiers and are paid under the Medicare physician fee service, and for the most part, they are paid an amount equal to what they would be paid if the services were provided in person.
Other Payers and Telemedicine
In 46 states and the District of Columbia, Medicaid offers some reimbursement for telemedicine services. Most of the services reimbursed by Medicaid are administered via real-time audio and / or video. Medicaid in 14 states pays for certain remote patient monitoring services. Nineteen states and the District of Columbia have passed laws requiring private payers to cover telemedicine services (the definition of which varies by state).
Some private health insurers provide coverage for telemedicine, with varying methods of determining what qualifies and how much is reimbursed. WellPoint, Aetna, and Highmark are three insurers that have gone into partnership with telemedicine companies to offer various types of telemedicine healthcare consultations in some plans.
Telemedicine Case Study Examples
The University of Virginia Center for Telehealth works across 118 sites to offer telemedicine services in over 40 specialties, including routine consultations, follow-up appointments, screenings, and emergency consultations. The Center has provided more than 39,000 patient encounters and has saved nearly 9 million patient travel miles.
In Arkansas, the Antenatal & Neonatal Guidelines, Education & Learning System (ANGELS) at University of Arkansas Medical Services offers patients 24/7 telemedical support services in cases of high-risk obstetrical care. The success of ANGELS has drawn attention from other specialties including mental health and pediatrics, and other states and countries (specifically India) have studied ANGELS for adaptation elsewhere.
The American Academy of Dermatology (AAD) sponsors the AccessDerm program that lets primary care physicians working in participating clinics that care for underserved patients have free dermatological consultations with AAD members. AccessDerm is currently available in 16 states and as of June 2014 has provided over 1,000 dermatology consultations to underserved patients.
Telemedicine has been growing steadily for years, and the recent statement by the AMA endorsing the use of telemedicine to improve access to care and keep costs down will only serve to raise the profile of telemedicine more. At AccessRx.com, we have been dispensing prescription lifestyle medications for over 15 years in coordination with US-licensed pharmacists, and are excited about the positive changes telemedicine promises. AccessRx.com is HIPAA-compliant, absolutely dedicated to a positive customer experience, and uses only the most advanced online security technology.