Tele­health ex­pan­sion re­quires ad­vances in pay­ment and cov­er­age poli­cies

Modern Healthcare - - COMMENT - By Dr. Na­bil El Sanadi In­ter­ested in sub­mit­ting a Guest Ex­pert op-ed? View guide­lines at Send drafts to As­sis­tant Man­ag­ing Editor David May at

Like many in­dus­tries, healthcare is at a cross­roads. One crit­i­cal de­ci­sion fac­ing prac­ti­tion­ers, es­pe­cially those of us who op­er­ate ma­jor healthcare sys­tems, is whether to in­vest more in our bricks-and-mor­tar oper­a­tions or in­crease fund­ing for cut­ting-edge tele­health in­for­ma­tion tech­nol­ogy so­lu­tions.

At Broward Health in Florida, my staff and I ask our­selves con­stantly: Which path do we take?

The an­swer is both. While there is no fu­ture in which the face-to-face re­la­tion­ship be­tween a pa­tient and doc­tor does not ex­ist—we will al­ways need fa­cil­i­ties—telemedicine’s po­ten­tial is not only blos­som­ing, it’s flour­ish­ing, even in dis­ci­plines that re­quire the clos­est in­ter­ac­tions be­tween pa­tients and doc­tors. To ex­pand ac­cess to care, save pa­tients pre­cious time and money, and im­prove the qual­ity of care, we all have to think more about telemedicine.

So must the state and fed­eral pol­i­cy­mak­ers who reg­u­late us.

Five years ago, per­haps even to most healthcare providers, telemedicine meant noth­ing more than sit­ting in your pri­mary-care doc­tor’s of­fice tele­con­fer­enc­ing with a spe­cialty-care physi­cian whose prac­tice was miles away. When I first at­tended the Healthcare In­for­ma­tion and Man­age­ment Sys­tems So­ci­ety an­nual con­fer­ence 10 years ago, there were a few ven­dors of­fer­ing telemedicine prod­ucts. To­day, thou­sands of telemedicine ven­dors at­tend the an­nual gath­er­ing.

Telemedicine is much more than emed­i­cal records and video chats; tech­nol­ogy is now a vi­tal tool in some of the prac­tice ar­eas thought to be the most hands-on.

For ex­am­ple, telepsy­chi­a­try is on the rise. Per­haps no doc­tor-physi­cian re­la­tion­ship is more in­ti­mate than the one be­tween pa­tient and psy­chi­a­trist or psy­chol­o­gist, but one of the bar­ri­ers to ac­cess­ing men­tal healthcare for some Amer­i­cans is the sim­ple no­tion of sit­ting face to face with a stranger, pour­ing out emo­tions. Telepsy­chi­a­try may elim­i­nate that anx­i­ety for some pa­tients—and pro­vide them a path to the qual­ity men­tal healthcare they so badly need, but might not have sought oth­er­wise.

With the per­sis­tent short­age of healthcare prac­ti­tion­ers in the U.S., hos­pi­tals have also be­gun to use telemedicine for in­ten­sive-care pa­tient man­age­ment. Tele-in­ten­sive-care units al­low highly trained crit­i­cal-care teams to re­motely mon­i­tor pa­tients in sev­eral lo­ca­tions at once. Tele-ICUs can im­prove pa­tient out­comes, re­duce mor­tal­ity and gen­er­ate cost sav­ings for pa­tients and hos­pi­tals—welcome out­comes in a care area that’s not only the costli­est, but the one with the high­est mor­tal­ity rate.

Even surgery has gone vir­tual. Us­ing robots they con­trol re­motely, physi­cians now op­er­ate on pa­tients from thou­sands of miles away. The first transcon­ti­nen­tal surgery was com­pleted 14 years ago. To­day, we can en­vi­sion a fu­ture where a top pe­di­atric sur­geon in the U.S. can op­er­ate re­motely on a sick child in the most far-flung, poor­est parts of the world.

In a decade or two, we could all be “doc­tors with­out borders.”

How­ever, to make that hap­pen, gov­ern­ment poli­cies must en­cour­age rather than in­hibit healthcare tech­nol­ogy.

Ac­cord­ing to a May 2015 Amer­i­can Telemedicine As­so­ci­a­tion re­port, is­sues sur­round­ing pay­ment and cov­er­age are one of the big­gest bar­ri­ers to telemedicine adop­tion. Only five states, ac­cord­ing to the ATA, have the nec­es­sary poli­cies in place to “ac­com­mo­date” telemedicine adop­tion. Also, states can still choose whether to cover telemedicine un­der Med­i­caid. Ac­cord­ing to a July 2015 re­port by the Cen­ter for Con­nected Health Pol­icy, three states still do not re­im­burse for live video tele­health; only 16 state Med­i­caid pro­grams re­im­burse for re­mote pa­tient mon­i­tor­ing; and 21 states do not of­fer a trans­mis­sion or fa­cil­ity fee when tele­health is used.

Also, fed­eral law, along with sev­eral state laws, does not yet re­quire pri­vate in­sur­ers to pro­vide cov­er­age for tele­health ser­vices.

This bias against tele­health is ironic given the fact that the U.S. mil­i­tary has long been on the cut­ting edge of tech­nol­ogy-based medicine. On the bat­tle­field, reg­u­la­tions and re­im­burse­ment poli­cies do not mat­ter. What mat­ters is sav­ing lives.

Out­side the bat­tle­field, state and fed­eral law­mak­ers of course must write rea­son­able reg­u­la­tions that en­sure the wel­fare of pa­tients. How­ever, telemedicine is safe, ef­fec­tive and im­proves ac­cess to qual­ity care, even in the dis­ci­plines that tra­di­tion­ally have re­quired face-to-face in­ter­ac­tion.

Our state and fed­eral re­im­burse­ment poli­cies sim­ply have not ad­vanced like telemedicine. An­ti­quated rules pre­vent doc­tors from im­prov­ing and sav­ing lives. It’s time for pol­i­cy­mak­ers to up­date our laws to ac­count for the bal­ance that Amer­i­can healthcare providers are strug­gling to achieve ev­ery day.

Dr. Na­bil El Sanadi is pres­i­dent and CEO of Broward Health, based in Fort Laud­erdale, Fla., and a board­cer­ti­fied emer­gency medicine physi­cian.

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