John C. Goodman,

CONTRIBUTOR

July 23rd, 2018

Telemedicine is making better care, quicker care and life-saving care available to more patients every day.

Thanks to technological breakthroughs, we don’t need to travel to a doctor’s office or a hospital for every medical need. We can get much of our care right in our own home.

“It used to be that you had to have very expensive equipment and you had to have T-1 lines to allow for video connections,” says Lauren Faison, Director of Telehealth at Tallahassee Memorial HealthCare (TMH), a non-profit community hospital in Florida. “But now with any kind of Wi-Fi signal and a secure software system and a camera, you can provide health care virtually.”

The biggest obstacles? Government. Insurance companies. Employers. They pay the bills. Not only have they been slow to take advantage of telemedicine, they are refusing to pay for most of it – even today. As I explained in a previous post, there are two things standing in the way: a payment system that is decades out of date and attitudes of some doctors whose mindset hasn’t changed since the Middle Ages.

Potential Benefits. The long reach of telemedical technology is being stretched every day:

• Highly skilled doctors at the Mayo Clinic can diagnose and treat stroke victims in real time at rural hospitals, miles away in southern Minnesota and parts of Iowa and Wisconsin. “They zoom in remote video cameras to get detailed focus on individuals. They watch blood pressure numbers and respiration,” explains Glen Stubbe, writing in the Minneapolis Star Tribune. These activities save lives and have life-long recovery effects.
• A nurse at Mercy Virtual Hospital in St. Louis can use a camera in a hospital room in North Carolina to see that an IV bag is almost empty. She can then call and instruct a nurse on the floor to refill it. The telemedicine cameras are powerful enough to detect a patient’s skin color. Microphones can pick up patient coughs, gasps and groans.
• After hip and knee replacements at Tallahassee Memorial HealthCare, patients are transported to rehab facilities, nursing homes and even to their own homes — where follow-up observations are made with video cameras. “When we have patients who need extra support, we can send them home with a Blue Tooth blood pressure cuff or a Blue Tooth scale and every morning when they get up, the nurse can see that information and react accordingly,” says Faison.

Some doctors and nurses see telemedical technology as competition, but almost everyone in the field has the opposite view: new technology is allowing medical professionals to do a better job. That said, there are many ways in which telemedicine is superior to traditional medicine.

“All the beeping monitors in the patient’s hospital room crank out massive amounts of information, presented in too cumbersome a way for nurses and doctors on site to deal with quickly,” writes Jasu Hu, at Politico Telemedicine provides a way to monitor and digest data streams, looking for signs of trouble.

Computer systems are also able to “see” things that humans might not see. “Critical care-trained nurses and doctors … can camera in and count the pores on someone’s nose,” a Mercy Virtual consultant explains.

Potential costs. Here is the $64,000 question: can telemedicine lower health care costs?

The answer I submit, is overwhelmingly “yes.” But that requires everyone to have an expanded view of what we mean by “cost.” All over the developed world people pay for health care in two ways: with time and money. And almost everywhere, they mainly pay for care with time and not with money by having to wait a long time for care or by having to travel long distances. Even for low-income patients, it appears that the time cost of care is a greater deterrent than the money cost. Telemedicine has the potential to solve that problem – if only we would let it.

TMH serves an 18-county region spanning southern Georgia and Northern Florida and that includes many rural regions. Some patients have to travel 2½ hours just to get from their home to the hospital. That means they must travel 5 hours round trip — for a doctor’s visit that may last only 10 or 15 minutes. Not surprisingly, many patients don’t make those trips – forgoing health care altogether.

Payer Resistance. “If I’m at home and I think my daughter has pink eye, I can log in, see a physician … and I don’t have to leave the house,” says Faison. The trouble is, Medicare won’t pay for that virtual visit. Nor will Blue Cross. Nor will most employer plans.

Faison estimates that telemedicine has reduced TMH readmissions and trips to the emergency room to the tune of $1 million a year. This has allowed the hospital to provide more care to more patients, who derive greater satisfaction from the care they receive. Yet insurers won’t pay for most of the telemedical services it provides.

After years of resistance, Medicare will now pay for telemedical services to rural areas. But it won’t pay for the same services in urban settings. That means that the hip replacement patient, recuperating at home, must get out of bed, travel to the hospital, wend his way to an examination room and then reverse that whole process  – at least if he expects Medicare to foot the bill. The patient must make that agonizing journey for an examination that could have been completed with the click of a button.

Telemedicine has great potential. It’s time to unchain it.