by Jillian McGehee, EditorTwo things are certain in health care – technology will evolve, and policy will change. With evolution and change come new ways to look at how care is delivered, and new avenues for patient care and access.
Telemedicine combines technology with policy and is currently surging across the country, as well as in Arkansas. Recent changes in telehealth laws enacted by the Arkansas General Assembly likely will facilitate even greater use of telemedicine.
Though it has enjoyed a long history, American telemedicine started coming more of age in the early 1990s as communications technology took off. In rapid succession, the World Wide Web opened up and became more user-friendly, the first webcam was built, the Pentium processor was introduced and the first smart phone was released. With the boom in telecommunications and computer technology came new applications related to health care, and in 1993 the American Telemedicine Association (“ATA”) was born.
The ATA’s stated goal is to promote access to medical care for consumers and health professionals via telecommunication technology, while working to transform health care by improving its quality, equity and affordability.
It’s no longer rare to see the elements of telemedicine integrated into the everyday operations of hospitals, specialty departments, home health agencies, private physicians’ offices and even consumers’ homes and workplaces, say association experts.
“But basically, telemedicine allows patients to remotely receive care from healthcare providers,” says Latoya Thomas, director of the ATA’s State Policy Resource Center. “Providers are able to provide care from one location to another through telecommunications.”
In Arkansas, as throughout the nation, people are used to having information at their fingertips. The readily available use of video and processing of data through means like FaceTime, Skype, Fitbit, Netflix, and various banking applications has changed the way people live and think, Thomas points out. The expectation for faster answers and easier access to what we want – whether movies on our phones or physician access on our computers – is prompting ever more creative uses of telecommunications technology that can be adapted to health care applications.
Overall, Thomas says, telehealth has improved health care and sets the stage for different schools of thought about where health care is headed.
“Today, folks are thinking differently about health care in general,” she says. “Hospitals are saying, ‘People trust us to come to provide quality care in every situation. Can we find ways to do that, even if don’t have, for example, a neurologist on staff or a psychiatric unit on the premises?’”
Telehealth is leveraging health care providers’ ability to connect patients with the care they need. “We’re also exploring this movement from the patient’s side,” Thomas adds.
“Patients want health care the way they want it. They want immediate answers and more than one opinion, and they also want to be able to measure the fiscal impact of any diagnosis on their lifestyle. They don’t want to fear being fired from their jobs if they have to take off from work to keep doctor’s appointments. More than anything, they want choice.”
Practicing medicine via telehealth reduces not just service-related costs, but also patients’ expenses, Thomas says. “It reduces patients’ travel time and related expenses when they must go a great distance to obtain care. It gives them more flexibility and choice.”
The American Hospital Association agrees. A 2016 issue brief by the association notes that “growing use of telehealth reflects larger health care trends that place the patient’s care and experience at the center of treatment decisions.”
Telemedicine services remove potential barriers to care by facilitating access to physicians, particularly specialists who may not be readily accessible in the patient’s local community. The American Hospital Association views the increased use of telehealth as an essential tool to help ensure patients receive the right care, at the right place, at the right time.
The ATA has found that health care providers also like the flexibility inherent in telemedicine delivery methods. “They appreciate the opportunity to provide sophisticated solutions for their patients,” Thomas says. Providers see telemedicine as an opportunity to improve patient outcomes and patient satisfaction.
In 2015, American Well®, a provider of telemedicine services, conducted a national survey in collaboration with QuantiaMD. Fifty-seven percent of the more than 2,000 primary
care physicians who responded to the survey stated they would consider video visits with their patients. In addition to improved patient outcomes, the responding physicians cited work-life balance as a motivating factor for increased use of telehealth.
A challenge to telemedicine policy relates to the lack of a national telemedicine standard of practice. Each state has its own laws governing the practice of telemedicine within its boundaries, and telemedicine policies don’t necessarily translate from state to state without restriction, Thomas says, noting this issue is not unique to telehealth and is common in other fields as well.
Another barrier to adopting telehealth services is a lack of uniformity in coverage and payment for this care. For example, a number of states have parity laws – laws that require private insurers to cover services provided by telemedicine to the same extent the service is covered when provided in-person – and this is an important development.
But parity laws do not address insurance coverage for technologies that have no in-person equivalent (such as using telemedicine for remote monitoring of patients with chronic conditions). To increase the use of telehealth, public and private payers must be willing to cover new services that are provided only through telemedicine.
Medicare and Medicaid coverage and payment policies also may present a challenge. Most state Medicaid programs provide coverage for telemedicine services, but the criteria for coverage differ among the state programs. Medicare has historically provided only limited telemedicine coverage, but recent proposals indicate that the federal government may be open to expanded coverage. Private insurance companies have been the most willing to cover these services after seeing the potential for efficient care and cost savings from pilot programs.
Toward the Future
The use of telemedicine is expanding in Arkansas and throughout the nation under the oversight of state regulatory boards and innovative health care providers and facilities. With its tremendous potential to expand patient access to care, while improving outcomes and promoting efficiency, expanded use of telemedicine is likely to have an important role in improving the U.S. health care system.