Tennessee needs proper adoption of telemedicine
Of the about 6.6 million people living in Tennessee in 2015, 4.2 million had at least one chronic medical condition like diabetes, heart failure, or hypertension. As we well know, these conditions are not easy to manage. In fact, they were the cause of death for at least 63% of the Tennesseans who passed away in 2017. Fortunately for Tennesseans, telemedicine promises to increase access to care, generate convenience, and improve health outcomes.
House Bill 1699, which was recently introduced in the Tennessee House of Representatives, would make it easier for patients and doctors to utilize telemedicine to achieve these goals. As part of the incoming generation of physicians, we support this bill and encourage you to join us for the reasons below.
Telemedicine is the act of delivering healthcare by electronic communication. This can take several forms: live video, store-and-forward, and remote patient monitoring (RPM). Live-video is a real-time interaction between a physician and patient who are in separate locations but connected via video call.
This is what most people tend to think of when they hear the words “telehealth” or “telemedicine.” Store-and-forward involves taking a picture or video of something related to a medical condition – say a rash – sending it to a physician to review, and receiving a diagnosis and treatment plan, based on the forwarded information, at a later time.
RPM involves recording physiologic data – such as blood pressure – electronically and sharing it with a physician who has the ability to make real-time adjustments to treatment plans or provide other recommendations based on that data.
Recently, a patient with heart failure confided in one of us about the difficulty of finding the time to drive two hours each way to see her cardiologist. This meant that when she started feeling short of breath and noticed swelling in her legs, she put off driving to Nashville to get the medical advice she needed.
Ultimately, a quick check-in with her cardiologist, who would have simply adjusted her medications and diet, would have likely prevented thousands of dollars of bills from the ambulance and her hospital stay. The hospital team overseeing her care recognized the barrier created by the distance between her and her cardiologist and saw telemedicine as the best way to overcome it.
However, despite their best efforts, lack of infrastructure and limited adoption of telemedicine in Tennessee prevented the team establishing electronic follow-up visits. As medical students, it is frustrating to know that the tools to provide better care are right at our fingertips, but out of reach of our suffering patients.
Evidence illustrating the benefits of telemedicine continues to grow. Effective implementation of RPM reduced 30-day readmission rates for congestive heart failure patients from 28% to 0% at a Massachusetts hospital. This accounted for $216,000 of savings every 30 days.3 Additionally, the use of RPM to help manage chronic disease has been shown to improve health outcomes including: lowering baseline blood sugar levels for patients with diabetes, reducing mortality for patients with cardiac electronic implantable devices (CEIDS), lowering the readmission rate for patients with congestive heart failure (CHF), and decreasing hospitalizations, ER visits, and average number of bed days for military veterans with diabetes.
However, Tennesseans have yet to experience many of the benefits that telemedicine can provide due to outdated legislation that doesn’t provide sufficient access to telemedicine in our state.
While Tennessee has an existing law about telemedicine, there is significant room for improvement to expand access to services and providers--especially for those living in rural parts of the state.
Fortunately, Rep. Robin Smith and 58 cosponsors introduced House Bill 1699, which gives patients more flexibility regarding where they may have a telemedicine visit. The bill ensures that providers are fairly reimbursed for telemedicine services by denoting parity with services provided in-person, and ensures that rural facilities hosting telemedicine visits are fairly compensated.
Additionally, this bill would recognize and clarify the coverage of remote patient monitoring services. If passed, House Bill 1699 would enact a consistent structure that encourages the appropriate use of telemedicine, thereby decreasing the impact of chronic disease on Tennesseans, improving our quality of life, and saving money that can be put to good use elsewhere.
Contact your state elected officials and ask them to support House Bill 1699 to improve access to well-coordinated care using telemedicine for patients all across our state. Your voice matters--just a few moments of your time can help make life easier, healthier, and cheaper for the majority of Tennesseans.
Megan Mcleod, Noah Harrison, Jenny Connell, Daniel Pereira, and Pious Patel are all medical students.