John Goodman, NCPA President
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By only reimbursing healthcare practitioners for face-to-face consultations and not allowing telemedicine to flourish, government and health insurers are keeping the practice of medicine in the Stone Age, according to Devon Herrick, senior fellow and author of the recently released study by the National Center for Policy Analysis (NCPA).
“Telemedicine provides patients with convenient high quality care for a lower cost,” noted Herrick, pointing out that “patients often find it difficult to take time off work to see a doctor. In the Information Age, location doesn’t matter.”
The NCPA study notes the practice of only reimbursing physicians for in-person visits punishes healthcare entrepreneurs working outside the traditional health insurance payment system via telephone, e-mail, text messaging and innovative computer software to make medical care more accessible and convenient for patients.
“Telemedicine could revolutionize the practice of medicine, especially for the chronically ill,” said NCPA president John Goodman, noting that more than 125 million Americans have chronic conditions, and that research has shown remote monitoring of patients with those conditions improves adherence to protocols and can be outsourced to low-cost, qualified medical providers.
The growth of telemedicine coincides with doctors’ increased Internet usage. According to a first quarter 2007 Manhattan Research Taking the Pulse® v7.0 study of 1,353 physicians, the trend of physicians communicating online with patients has grown since 2003 from 19 to 31 percent. Among physicians who have not yet used an online secure messaging service, 24 percent intend to start using one in the next 12 months. Among the physicians who communicate with patients online, the most popular activities include answering clinical questions, discussing symptoms and treatment options, and determining whether an office visit is necessary.
For example, by allowing patients to schedule an appointment or email questions Dr. Alan Dappen, a Virginia physician, has become more efficient in his medical practice. He bills patients in 5-minute increments ranging from $25.50 for in-office visits to $17 for phone consultations. His office helps patients with insurance billing and allows them to pay online using PayPal.
Issues and Obstacles
According to the Center for Aging Services Technology, “research has demonstrated that, on average, patients managing their CHF (congestive heart failure) via telehea0lth can reduce their healthcare utilization — physician office visits, emergency department visits, and rehospitalization — by 30 percent. If nothing changes, the cumulative costs of CHF from 2005 to 2030 will be nearly $1.5 trillion. If telehealth could reduce CHF healthcare utilization by 30 percent during this period, there would be a cost savings of approximately $442 billion.”
In the Sept. 24, 2007 report to the National Commission for Quality Long-Term Care, the authors noted “it will take more than just changes in policy and reimbursement schedules to enable the widespread use of telemedicine; it will also require effective data exchange between many types of portable devices and the tools that can manage those data — namely PHRs and EHRs.”
To justify investment and reimbursement coverage on the basis of health improvement value, the American Telemedicine Association maintains an expansive library of clinical studies.
Telemedicine could revolutionize efforts at cost control, said Goodman.
“Just as the widespread use of the Internet lowered seller markups on every product from automobiles to groceries, and just as e-Bay has lowered the resale price of just about everything, telemedicine promises to have a huge impact on healthcare prices . . . unless no one is actually competing based on price,” he explained. “In a system of nonprice rationing, telemedicine is not necessarily a boon to cost control. In fact, it could prove to be a disaster. If every Canadian patient had access to free telemedical services, it would bust the global budgets in every Canadian province in the space of a few weeks.
“That may explain why the principal obstacles to telemedicine are health insurance companies and government. As buyers of care, these two bureaucracies resist paying for anything other than face-to-face medical encounters for the same reason the Canadian government is likely to be resistant.”
As a regulator of care, government has erected another set of obstacles, noted Goodman.
“It’s illegal for a doctor practicing on the Texas side of Texarkana to treat a patient by phone on the Arkansas side of the same city,” he pointed out. “It’s illegal for a doctor practicing in East St. Louis (Illinois side) to interpret x-rays taken for a patient treated in west St. Louis (Missouri side). Unless these relics of misguided regulatory excess are repealed, the telemedical marketplace each of us has access to may be limited by the borders of the state in which we live.”
Innovative Healthcare Delivery
Goodman pointed to TelaDoc Medical Services (www.Teladoc.com), a free-market development in telemedicine occurring outside traditional insurance, as an example of innovative healthcare delivery.
In December, TelaDoc passed the 1 million mark of patients who subscribe to the nationwide service. For a low $35 consultation fee, enrollees can talk to a doctor by phone, any time day or night. TelaDoc maintains electronic medical records online, allowing physicians access to accurate patient records anywhere in the country. In most cases with TelaDoc, people who use the service pay with their own money. In some incidences, an employer pays the enrollment costs, but health insurers rarely reimburse for the service.
“TelaDoc offers health plan sponsors and their members age 12 and older convenient, cost-effective access to board-certified physicians, allowing members to avoid the expense and time of urgent care facilities, emergency rooms or visits to the doctor,” said Michael Gorton, chairman and CEO of TelaDoc. “This innovative cross-coverage methodology, whereby other physicians cover for them after hours, improves access to health services and significantly lowers the cost of medical care – two of the leading problematic issues in our nation’s healthcare system, which are breaking the back of American corporations, individuals, and the uninsured and underinsured.”
Once enrolled, plan members simply call TelaDoc to request a consultation and a return call from a doctor within three hours is guaranteed. TelaDoc consulting physicians recommend treatment and prescribe short-term medication if appropriate (excluding DEA or controlled substances) over the telephone 24 hours a day, 365 days a year. The prescription is then called into the member’s pharmacy.
“TelaDoc exemplifies the strength of a private sector initiative to lower healthcare costs, improve consumer access to quality services, and provide convenient healthcare for all Americans,” said Tommy Thompson, former U.S. Secretary of Health and Human Services and Governor of Wisconsin. “The inclusion of a portable electronic health record that is free to both physicians and patients is of special value to our entire healthcare system, bringing us a step closer to streamlined continuity of care.”
Aetna Endorses Telemedicine Practices
In December, Aetna (NYSE: AET) and RelayHealth, a subsidiary of McKesson Corporation, endorsed telemedicine practices when it announced that Aetna has significantly expanded the reach of its online communications services.
Members and physicians, now including physicians in more than 30 medical specialty categories, participating in most of Aetna’s medical plans nationwide, now have access to RelayHealth’s webVisit® consultations. These clinically structured online interviews offer patients a convenient, affordable and efficient way to report non-urgent symptoms. Physicians, in turn, can deliver timely, informed responses.
The move marks the latest development in Aetna’s plans to broaden the accessibility of reimbursable online consultations and other secure messaging services through RelayHealth’s intelligent network. These services include appointment requests, referrals, lab and test results, and prescriptions and medication refills.
“Physician-patient online communications are fueling patient participation and empowerment as patients become more savvy healthcare consumers,” said Paul Marchetti, manager of Aetna’s national networks and contracting services. “For many doctors, the ability to discuss non-emergency conditions online with their patients can save time and money. Doctors may find that online, structured communication helps them determine key patient information quickly and decrease misinterpretations caused by language barriers. It also may provide a more accurate record.”
Coverage for RelayHealth online visits is now available to most fully insured plan members. Self-insured plan sponsors may choose to participate.
“RelayHealth gives patients efficient online communications with our office for appointments, referrals, medication renewals, medical information and questions concerning their care 24 hours a day,” said Dr. Roy Greenberg of Hill Physicians Medical Group in Folsom, Calif. “Patients being held hostage by the phone and office hours are a thing of the past. We strongly feel RelayHealth provides superior service and care, providing a very positive experience for both our 3,000-plus registered patient users and staff.”
March 2008 |
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