Sign Up for the Stateside Dispatch, our twice weekly email of news & analysis.

Telehealth: Merging of Technology and Medicine Leads to Improved Healthcare

Monday, May 19, 2008

http://www.progressivestates.org/dispatch

EVENT: Conference call on renewable energy

WHAT: Discussion of how Colorado has become a leader in renewable energy development and suggestions for how states across the country can move similar alternative energy agendas.
WHEN: Friday, May 23rd, 12 pm EST, 10 am MST
WHO: Alice Madden, Colorado House Majority Leader
          Tom Plant, Director of Colorado Governor's Energy Office
          Pam Kiely, Legislative Program Director, Environment Colorado
DIAL-IN: 1.800.391.1709, log-in code 709424
RSVP: send an email to aguest@progressivestates.org with your name and contact information

Valuing-Families

BY Julie Schwartz

Telehealth: Merging of Technology and Medicine Leads to Improved Healthcare

States can help make health care more accessible and affordable by utilizing modern day technology. In 2007, the United States spent over $2 trillion for health care, yet consumers are still facing rising medical costs and are concerned about their access to quality medical care.

Traditional health care usually involves only face-to-face interaction between doctors and patients.  In remote and isolated areas, face-to-face interactions are hindered by obstacles such as distance and time constraints.  Routine monitoring of patients with chronic disease require costly repeated trips to specialists.  These obstacles can make providing medical treatment exceptionally expensive. By merging technology and health care, however, state policymakers are creating new opportunities for medical professionals and patients to interact in more efficient ways. The use of technology in health care -- often called telehealth -- utilizes broadband applications to remotely monitor patients, facilitate collaboration between medical professionals, exchange medical data and images, and instantaneously provide efficient emergency service to remote areas.  Making medical care more accessible and convenient to patients, and raising the quality of services while reducing the costs. 

More Resources

Tell a Friend About This

Benefits of Telehealth:  Expanding Access to Health Care While Reducing Costs

The potential benefits of telehealth include saving lives, increasing access to and quality of medical services, and reducing medical costs.   The benefits for rural areas are especially clear, but a range of patients and health facilities will benefit from greater electronic networking of our health care system.

Telehealth can provide rural areas or communities facing medical staff shortages with enhanced medical care:  In rural areas where the ability to access health care can be challenging, technology links doctors and patients via high-tech, virtual interstates. Video consultations, video collaboration and the ability to transmit high resolution images from a rural clinic to a specialist or urban medical centers can alleviate prohibitive travel and associated costs for patients.  Through telehealth, patients, especially those living in under-served areas, receive more timely medical care and gain access to previously unaccessible specialty care.

Residents of rural communities generally have less access to medical care, and are often forced to travel several hours each way to a major hospital. The trouble and expense of traveling for doctors visits takes a toll on anyone, especially those living in more isolated locations or suffering from debilitating illness. Telehealth applications, such as remote monitoring, video consultations, and advanced imaging can significantly reduce the amount of travel associated with providing health care services.

In addition, telehealth programs help leverage the resources at better funded urban hospitals to support rural medical centers. Instead of driving four hours to have an expert examine an X-ray a rural patient can have the X-ray done close to home and send the image to any expert anywhere in the world. Additionally, using broadband for video conferencing, smaller clinics and doctor’s offices can network with major urban hospitals to provide state of the art care. Telehealth will allow rural residents to receive the best medical care possible without the hassle or expense of leaving their communities.

The Georgia REACH Program:  In Georgia, telehealth has been used to save lives and minimize the negative effects of strokes on rural citizens.  TheREACH(Remote Evaluation of Acute Ischemic Stroke) program uses high-speed broadband to allow doctors to examine the patient, determine the type of stroke and prescribe the correct medicine all via video conference.  The telehealth program connects the Medical College of Georgia’s neurology department with ten rural hospitals.  When a patient has a stroke there is a short three hour window for doctors to determine if the stroke was caused by clotting or bleeding

Depending on diagnosis, the right course of treatment is instituted.  The medical treatment for a stroke caused by clotting, however, can have devastating effects if given to a patient who is having a stroke due to bleeding and vice verse.  Therefore, an examination by a professional is needed before treatment can occur.  Since the time it would take to transport a patient from rural Georgia to a qualified treatment center is longer than the 3-hour window, previously there was little rural hospitals could do for stroke patients.  Today, with telehealth a neurologist anywhere in the world is able to provide the necessary examination and diagnosis so that rural hospitals can begin treatment.  Telehealth has increased rural hospitals ability to effectively treat stroke victims.

Teleheath allows sharing of Medical Resources: Telehealth can also help communities share medical resources when shortages exist.  In Maryland six hospitals facing a shortage of emergency room doctors plan to use physicians in Delaware to electronically monitor intensive care patients.  Under the program known as Maryland eCare, a critical care doctor, or intensivist, based at a command center in Wilmington will oversee overnight care for as many as 150 patients and provide guidance to on-site nurses. Officials said the collaboration with the hospitals, the first of its kind in the nation, is needed, especially in exurban and rural areas. 

Telehealth can allow better management of chronic illness at a lower cost:  There are estimates that more than 90 million Americans live with chronic illness and that 7 out of 10 deaths are caused by these conditions.  Chronic health conditions, often requiring long term care and generally difficult to treat in the most equipped medical centers, are even more cumbersome to handel for rural medial clinics which often lack the resources necessary for effective diagnosis and treatment.  Telehealth presents one of the best hopes for addressing this problem in both urban and rural communities.

According to the American Telehealth Association, agencies that use remote monitoring technologies can provide home care in a more timely and targeted way than scheduled home visits would typically allow. Instead of visiting the patient once a week or once a month, providers can monitor the patient daily and make real-time identifications and interventions in the care of their patients.  These early interventions are vital to the improvement of symptom management, improved health behaviors, compliance with medications and treatments, and reduction in unnecessary health care encounters, such as hospitalization. 

Specifically, it has been found that remote monitoring can decrease the amount of time patients must spend in the hospital, either for regular doctor visits or longer term medical care. In fact, studies show that remote monitoring decreased the length of hospital stays from 14.8 days to 10.9 days, office visits by 10 percent, home visits by 65 percent, emergency room visits by 40 percent, and hospital admissions by 63 percent.

Telehealth can increase training for medical professionals:    Videoconferencing also opens up new possibilities for isolated or rural health practitioners to participate in continuing education and training programs. 

Telehealth has the potential to reduce health care cost: The utilization of telehealth technology has the potential to deliver huge cost savings to America's health care system of over $300 billion annually.  Aside from the cost savings associated with remote monitoring, it is estimated that from a baseline of 2.2 million patients transported each year between emergency departments at a cost of $1.39 billion in transportation costs, hybrid technologies would avoid 850,000 transports with a cost savings of $537 million a year. For example, a recent State University of New York study found that patients using telehealth to manage congestive heart failure experienced a reduction in overall health care costs of 41%.  Reduced physician office visits alone offered a savings of more than $115 million annually.

Further, telehealth seems to offer some relief to the strain the aging baby-boomer population will place on the health care system. A study by Robert Litan, projected that broadband-based monitoring could cut medical costs for senior citizens by about 30%.

More Resources

Tell a Friend About This

Making Telehealth a Reality

Although telehealth has been around for years, its promises have not been truly realized.  The obstacles to achieving the full potential of telehealth include the lack of widespread broadband technology, the way in which Americans pay for health care, and how physicians are regulated by the government.


The Need to Build-out Broadband Technology

The most significant hindrance to large scale adoption of telehealth has been the lack of widespread broadband deployment capable of supporting advanced Internet applications. While telehealth provides many benefits, such as transmitting detailed images, remotely monitoring patients at home and utilizing advanced teleconferencing technology for collaboration, trainings, and patient visits, it also requires sophisticated broadband services, something must rural hospitals and homes do not have. Without increased broadband deployment, development of telehealth technology will be slow, and the true service enhancment and cost savings will never be realized.

The Federal Communication Commission (FCC) has recognized that broadband is a means to efficiently deliver health care services.  The Commission has stated that broadband deployment in rural America one of its top priorities. Last year, the FCC allocated $417 million for the construction of 69 statewide and regional broadband telehealth networks in 42 states and three U.S. territories under the Rural Health Care Pilot Program.  Some examples of projects funded by the Rural Health Care Pilot Programs:

  • Rural Western and Central Maine Broadband Initiative $3.6 million was awarded to build new, high-speed fiber optic cable network which will serve approximately 80 health care facilities. 

  • The Southwest Telehealth Access Grid (Arizona, New Mexico, Texas, Colorado) will distribute telehealth clinical services, educational and training programs to approximately 60 facilities within the states and the Southwest Indian Services consortium.  University of New Mexico's Center for Telehealth and Cybermedicine Research received over $15 million to design and deploy the grid.

  • Erlanger Health SystemRural Health Care Fiber Network (Tennessee, Georgia) – This Chattanooga-based non-profit received over $2 million to extend an existing fiber network to deliver patient care, video consultations, data exchange, and a virtual nursery to approximately 11 health care facilities serving residents in sparsely populated regions of southeast Tennessee and smaller areas of northern Georgia, western North Carolina, and northeast Alabama. 

  • Illinois Rural HealthNet Consortium – This statewide network will serve approximately 87 health care facilities and connect to Internet2.  More than 95% of the connected locations will have connectivity at speeds ranging from 100 Mbps to 1 Gbps.  The FCC pledged a maximum support of $21 million.

  • The Alaska Native Tribal Health Consortium, which largely consists of rural health care professionals, would receive approximately $10.4 million and connect approximately 270 facilities throughout Alaska and the lower 48 states.

  • The California Telehealth Network received more than $20 million to link about 300 rural California facilities, thus improving patient-physician interaction for a population that suffers disproportionately from depression, hypertension, asthma and cardiovascular disease. 

  • The Iowa Rural Health Telecommunications Program would use more than $9.9 million to link nearly 100 facilities in Iowa, Nebraska and South Dakota, helping solve the problems of geographical isolation and limited resources that constrain health care delivery in rural Iowa and surrounding regions;

  • The New England Telehealth Consortium, a multi-state telehealth network, will be given around $24 million to deliver remote trauma consultation and expansive telehealth by linking approximately 500 primarily rural health care facilities – including hospitals, behavioral health sites, correctional facility clinics, and community health care centers – in Vermont, New Hampshire and Maine to urban hospitals and universities throughout New England.

  • The University Health Systems of Eastern Carolina would use approximately $960,000 to add 16 mostly rural health care facilities in 12 counties to an existing network to better serve a population suffering from a significantly higher incidence of chronic disease than the state and national averages; and

  • The West Virginia Telehealth Alliance would use nearly $8.4 million to connect 450 facilities and target regions of the state that have large populations of poor and elderly patients suffering from chronic medical conditions.

State legislatures need to invest in broadband deployment so that their residents can start to use advanced technological applications such as telehealth. 

More Resources

Tell a Friend About This

Reforming Medical Licensing Rules

Regulating health care professionals by way of licensure reduces the harm from inconsistent and negligent medical care, but also acts as a barrier to telehealth programs. With more than half of the states adopting restrictive licensure positions with respect to telemedical practice, a significant barrier now exists, which inhibits access for patients and increases the costs of providing services for health care organizations and independent providers. 

State legislatures have oversight responsibility for medical boards, dictate medical practice policies and establish licensure fees. Each state has established its own rules over educational and performance standards with which each medical professional must comply.

As of 2007, more than 35 state medical boards have restrictive licensure language in place. It is of utmost importance that state licensure regulations and legislative policy support the provision of health care across state lines.

Currently, doctors who want to practice medicine in more than one state must apply for a separate medical license in each state. A model state law drafted by the Federation of State Medical Boards, however, creates reciprocal agreements among states, allowing doctors with a license in any participating state to practice in all other participating states.  So far, only 10 states — Alabama, California, Minnesota, Montana, Nevada, New Mexico, Ohio, Oregon, Tennessee and Texas — have enacted the model statute, according to the Center for Telehealth and E-Health Law.

A report financed by funds from the US Department of Health and Human Services, Office of the National Coordinator for Health IT (ONC) under a contract with the National Governors Association Center for Best Practices for the State Alliance for e-Health outlined models that may aid in reducing barriers to interstate practice >  Such models may include: <

    • Endorsement: State boards can grant licenses to health professionals in other states that have equivalent standards. This model allows states to retain their traditional power to set and enforce standards. Since providers must apply for a license in each state within which they wish to practice, complying with diverse state requirements can be time consuming.
    • Reciprocity: “Many states allow out-of-state licensed [providers] to receive an in-state license through abbreviated licensing processes such as endorsement, registration, or reciprocity. This does not necessarily eliminate the administrative and costly burden of obtaining licenses in multiple states, but it may reduce it. The physician, however, would be subject to multiple state medical boards' statutes and regulations upon abbreviated application approval.”
    • Mutual recognition:  A system in which the licensing authorities voluntarily enter into an agreement to legally accept the licensure policies and processes of the licensee’s home state.
    • Registration: A model that permits a health professional who wishes to practice part-time in another state to inform the board of the other state and agree to operate under the legal authority and jurisdiction of that state.
    • Limited licensure system: A licensure model that limits the scope of practice by allowing for the delivery of specific health services under a defined set of circumstances.
    • Certain licensure exceptions such as the consulting exception whereby a physician who is unlicensed in a particular state can practice medicine in that state at the request of, and in consultation with, a referring physician

More Resources

Tell a Friend About This

Changing Medical Reimbursement Policies

The absence of consistent, comprehensive reimbursement policies is another serious obstacles to the integration of telehealth into health care practice. This lack of an overall telehealth reimbursement policy is a product of the multiplicity of payment sources and policies that currently exist within the United States health care system. For telehealth technology to achieve sustainability, states must require Medicaid, a significant payer for medical services, to set the standard and reimburse providers for telehealth services. If Medicaid recognizes the value added by telehealth, private payers will soon follow suit. The Centers for Medicare and Medicaid Services' (CMS) web site notes that, “Medicaid reimbursement for services furnished through telehealth applications is available, at the state’s option, as a cost-effective alternative to the more traditional ways of providing medical care.” 

Currently, at least 35 states reimburse for telehealth services.  In a survey done in 2004, at least 27 states reimbursed for telehealth through Medicaid. What services were covered by Medicaid, however, looked different state to state:

  • Medical consultations or treatments – 22 states 
  • Psychological consultations or treatment – 12 states 
  • Home health – 2 states 
  • Case management – 2 states 
  • Patient education (diabetes) – 1 state

In 2008, states continued to enact some form of telehealth medicaid reimbursement legislation, however, not ever bill covered the same level of services. 

  • In Washington, SB 5930, which relates to high quality, affordable health care, was signed by Governor Gregoire on May 2. The legislation stated that the new state funded health care plan among other things needs to pay for e-mail consultations, , and telehealth when doing so reduces the overall cost of care, and identify any existing barriers and opportunities to support implementation, including needed changes to state or federal law.
  • In Utah, HB 16allows used for certified services to be reimbursed under the State Medicaid plan.
  • The Colorado state legislature passed SB 68, which permits Medicaid reimbursement for mental health care services.

It is important that not only Medicaid but private insurers reimburse for telehealth services for maximum gains from .  In at least five states— Louisiana, California, Oklahoma, Texas and Kentucky — lawmakers have passed legislation mandating that private payers reimburse for telehealth.  Hawaii prohibits private insurers from discriminating against telehealth services, while other states encourage third party payors to reimburse for telehealth services. For example, New Mexico SB 456 encourages health insurers, health maintenance organizations, managed care organizations, and third-party payors to use and provide coverage for telehealth within the scope of their plans or policies.

Even if they are not required to, some private insurers are starting to reimburse for telehealth services. In February of 2008, Aetna Inc., the nation's largest insurer, and Cigna Corp. have agreed to reimburse doctors for online visits. The virtual visits are considered best for follow-up consultations and treatment for minor ailments such as colds and sore throats. Additionally, some specialists, including cardiologists and gynecologists, also see e-mail as ideal for periodic checkups that do not require in-person visits.

More Resources

Tell a Friend About This

Conclusion

Telehealth is one of the more promising broadband applications, with the ability to save lives and increase access to quality health care at a reduced cost. It is dependent, however, upon development of faster and more ubiquitous high-speed services, and software applications that can link patients, patient records, doctors and medical facilities.  In order for states to be able to leverage the applications of tomorrow they must foster universal and affordable broadband strategies, as well as address licensing and Medicaid reimbursement issues. 

*Correction*

In Thursday's Dispatch, we mistakenly characterized Iowa's  HF 2645  (vetoed by the governor) as a "fair share" bill when in fact it was designed to expand the scope of public sector bargaining to allow public sector unions and management to bargain over the same things as the private sector. 

Masthead

The Stateside Dispatch is written and edited by:

Nathan Newman, Policy Director
J. Mijin Cha, Policy Specialist
Christian Socaris-Smith, Policy Specialist
Julie Schwartz, Policy Specialist
Adam Thompson, Policy Specialist
Austin Guest, Communications Specialist

Please shoot us an email at dispatch@progressivestates.org if you have feedback, tips, suggestions, criticisms, or nominations for any of our sidebar features.

Progressive States Network - 101 Avenue of the Americas - 3rd Floor - New York, NY 10013
To unsubscribe: Click here

101 AVENUE OF THE AMERICAS 3RD FLOOR NEW YORK, NY 10013
212.680.3116 | 212.680.3117 (fax)