The Doctor Will See You (via Computer) Now
Telemedicine got its start about 40 years ago in order to bring medical services to underserved patients in remote areas in the United States and worldwide. Today, it’s integrated across the spectrum of healthcare from hospitals to physicians, those in private practice, home healthcare services, and health insurance companies.
The American Telemedicine Association formally 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.”
That communication can be phone consultations, text messages, emails, transmission of images, patient website portals, nursing call centers, virtual continuing medical education, remote monitoring of vital signs, and live video appointments. All of those methods and more fall under the umbrella of telemedicine. It’s changed and is continuing to reshape the field of medicine and healthcare delivery.
Accessing Experts When Seconds Count
An estimated two million brain cells are lost for each one-minute delay in restoring blood flow after a stroke. Timely administration of tPA, a clot-busting drug, is critical to avoid irreversible brain damage in stroke patients. But some emergency room physicians may not have access to a neurologist with vascular training to conduct the proper evaluation before giving the drug. The benefits of the drug are well-established, but it may not be appropriate for some patients, thus careful screening is required.
Since 2009, the UCLA Telestroke program has been helping area emergency departments make critical decisions about tPA and stroke care at large. The program provides 24/7 on-demand care to affiliated emergency departments.
“Many emergency room physicians are uncomfortable making a decision about thrombolytic therapy,” explains vascular neurologist Latisha Katie Ali, MD, UCLA Telestroke program. “Through our televideo systems, we are able to conduct a visual exam, take a clinical history, review the neuroimaging and rapidly assess patients in a way that potentially changes their management.”
Web-enabled Devices Needed
Rather than driving to a doctor’s office, telemedicine providers offer patients the ability to connect to physicians using web-based technology on a computer, smartphone or tablet. For live video appointments, your device must have video and two-way audio capability along with high-speed internet access. A secure link is typically sent via email with the appointment confirmation. Most newer laptop computers and tablets have built in audio/video as do cellphones.
Telemedicine and Medicare
In a recent study, Harvard Medical School researchers examined Medicare claims data and found that the number of telemedicine visits provided to Medicare beneficiaries significantly increased. In 2013, 107,000 telemedicine visits were conducted. This is one of the first studies to measure how often telemedicine is being used. The results were published in the May 2016 issue of JAMA.
Currently, Medicare limits payment for telemedicine care to patients living in rural areas who receive a live-video visit at a clinic or other facility (in other words, not at patients’ homes). Despite these restrictions, telemedicine use within the Medicare program is growing. According to the Harvard study, disabled beneficiaries with mental illness, who were sicker than then average Medicare users, were most likely to have received telemedicine services.
More than half of U.S. states have passed parity laws mandating that telemedicine visits be reimbursed at the same rate as an in-person visit. Many private insurers also pay for telehealth visits. For example, Aetna and United Health Care cover telemedicine visits for their members who are underage 65—regardless of where they live. As for Medicare, which is extremely slow to adopt, there is some forward motion. Anthem, which provides optional managed care benefits to Medicare Advantage members, offers a telemedicine option to its members.
Direct-to-Consumer Consultations
A growing number of health insurers and hospitals offer online assessments and physician services for common conditions like flu, minor rashes and ear pain. Patients fill out an online form, and a team of local medical providers diagnoses and treats these common medical conditions. Responses typically take an hour or less, and some automatically send prescriptions to a patient’s pharmacy of choice.
As practical as these services may be, telemedicine, also known as telehealth and mhealth (the “m” stands for mobile), has its downsides. Unscrupulous players have entered the scene, offering to instantly solve what ails you. A July 2016 study published in JAMA Dermatology raised concerns about the quality of some telemedicine websites. In the study, participants posed as patients and submitted a variety of dermatologic cases with photos. The providers made several correct diagnoses, but many major diagnoses were repeatedly missed, and prescribed treatments weren’t always in keeping with existing guidelines.
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