FORBES: Telemedicine Is A Game-Changer For Patients, The System

Article From OnForb.es

While 87% of Americans now have health insurance, overwhelming co-pays, high deductibles and a lack of primary care doctors still stand in the way of healthcare for many.

An average GOLD level plan—one of the more expensive, “better” insurance plans—still has a deductible of $2,000 for an individual, which approximately 40% of Americans cannot afford. Thirty-five percent of Americans already struggle with medical debt despite that 70% of those struggling have insurance. And by 2025, the United States faces a potential physician shortage of as many as 52,000.

For many, new health insurance is not providing access to affordable care, and the ACA will not address the physician shortage. To bridge that gap, we must find innovative ways facilitate hassle free access to a provider that is more cost-effective. Telemedicine is a growing model that is a part of the answer.

Telemedicine, or “telehealth,” is the provision of remote access to a physician via phone or videoconference to address a health care issue. It’s not a new concept. It’s well-established in rural areas for specialty consultations, and has been widely used in many primary care practices like pediatrics as a practical matter (although most pediatricians do not bill for phone consultations).

More broadly, telehealth is gaining ground as an alternative to urgent care or the emergency department for more minor concerns like ear infections and colds. This week, Blue Cross Blue Shield of Massachusetts announced that it is offering video visits to patients within two physician groups. BCBSMA Director of Network Innovation Greg LeGrow told MobiHealthNews that video visits have the potential to improve cost, access, quality, efficiency, as well as patient and physician satisfaction.

Data show that telemedicine can deliver quality outcomes comparable to in person office visits.  A 2011 Center for Disease Control study showed eighty percent of adults discharged from the emergency room-meaning patients who could be treated and sent home-said they sought care at the ER due to lack of access to a primary care provider (PCP). However, the ER is also the most expensive and least efficient way to provide non-emergent care, costing from $1,500 to $3,000 on average compared to $130 to $190 for a PCP visit. A telemedicine visit can cost as little as $40.

Access to a telemedicine provider can prevent an ER visit on a Saturday night or prevent the need to arrange travel, childcare, or time off from work for an office visit during the week. Telemedicine is not designed to replace the need for a relationship with a PCP, but serves as a convenient and cost-effective alternative.

There are multiple barriers to the widespread uptake of telemedicine, but the most prohibitive are regulatory policies at the state level. The laws in many states either severely limit or completely ban the practice of telemedicine. But the truth is telemedicine is a tool used to practice medicine, not the practice of medicine itself. This is an important distinction to make in order to craft laws that govern its use.

As of February 2015, 36 states have introduced 100 varied bills related to telemedicine. We need to see state legislation with the following four elements.

First, the legislation needs to provide payment parity. This means requiring insurers to reimburse licensed health care providers for services delivered remotely at the same rate they would pay if the visit were in-person. There should be no financial incentive to treat a sore throat in person versus with a telemedicine consult, because the reimbursement to the provider should be the same. Currently only 21 states and D.C. have parity legislation, and of those only 15 do not have provider or technology restrictions.

Second, the legislation should establish that the same standard of practice applies whether the services are delivered in person or remotely. This means codifying that the questions and “images” a physician uses to adequately diagnose and treat a condition are the same whether they are gathered in person or over the phone and with pictures.  This would clearly distinguish telemedicine as the tool that it is, rather than the practice of medicine.

Third, the legislation would prevent the creation of more restrictive licensing requirements by the medical licensing entity in the state for delivering services via telemedicine. Specifically, the legislation should prevent the use of additional rules requiring in person visits before or after telemedicine encounters or the presence of care facilitators during an encounter. These types of restrictions make it almost impossible to deliver quality, cost-effective care remotely, or via telemedicine, and prevent the use of many current telemedicine business models in our state. Currently 27 states and D.C. have legislation that is telemedicine friendly. However, Alabama, Arkansas, Missouri, Nebraska and Texas require an initial in-person visit before a telemedicine visit and Alabama, Texas and Georgia require in-person follow up visits.  These laws effectively eliminate the possibility of most telemedicine models from operating in the state.

Fourth, the state licensure requirements should allow exemptions for telemedicine. All states currently have some restrictions on physicians practicing out of state despite that the Federation of State Medical Boards (FSMB) offers a uniform licensing procedure and guidelines. Each state has a different set of policies and practices and only D.C., Maryland, New York and Virginia have reciprocity agreements with bordering states. Currently, there are 10 states that have conditional licenses for telemedicine for out-of-state physicians.

As a physician, I understand clinicians can be skeptical of new practice modalities and strategies because that is not how we were trained, and we want to see the evidence. The good news is that we have evidence telemedicine works, is safe, and cost effective. Providing Americans with Accessible, Affordable Care, is going to require a new strategy. Telemedicine can, should, and quite frankly will be a part of that strategy.

The patient-consumer has spoken, and they want to access primary care on their own terms, not those of the healthcare industry. They want to be able to use their smart phones to find providers, schedule appointments, and view their medical records. With telemedicine they could also see a physician. This issue is picking up steam. But this is only possible if states remove the current regulatory barriers to care.

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