Telehealth at a tipping point for changing healthcare delivery

In an article and in testimony before a federal panel, Eric Topol, MD, and Ray Dorsey, MD, contend it’s time that incentives support wider use of telemedicine.

____simple_html_dom__voku__html_wrapper____>Fueled by three important trends, the time has come for healthcare to embrace telehealth as a technology platform for achieving increased industry efficiencies and providing greater patient access to care.

So argue Eric Topol, MD, director of the Scripps Translational Science Institute in La Jolla, Calif., and Ray Dorsey, MD, director of the Center for Human Experimental Therapeutics at the University of Rochester Medical Center in Rochester, N.Y.

Writing last week in the New England Journal of Medicine, Topol and Dorsey contend in a review article that telemedicine has reached a tipping point and has the potential to dramatically transform the delivery of healthcare for millions of Americans. Thanks to three trends, the authors make the case that the widespread adoption of telehealth is rapidly approaching, especially given the ongoing doctor shortage and the industry’s growing burden of managing chronic diseases.

They say the first trend is driven by the potential of telemedicine to make care more accessible, convenient and reduce cost. The second trend is the expanded application of telehealth in its traditional use in acute conditions, such as telestroke programs that connect neurologists with physicians in distant emergency departments, to episodic conditions, such as a consultation between a pediatrician and a school nurse to diagnose an ear infection in a child, to the ongoing management of chronic conditions. And the third trend is the migration of telemedicine from hospitals and clinics to patients’ homes and ultimately mobile devices.

“There isn’t any question about it—telehealth has major momentum now, despite some of the obstacles such as reimbursement,” says Topol. “It’s made tremendous inroads in a very short amount of time. What we’ve learned is that telemedicine is a very efficient way to expend medical care, and it’s going to grow over time. At some point in the future, within the next decade, it will likely be the most dominant form of physician-patient interaction.”

While on average it takes patients 2.6 weeks to make an appointment with a primary care physician, Topol asserts that with telemedicine, they could be “connected in 2.6 seconds or less” with a doctor.

Still, he acknowledges that telehealth today is “relatively primitive” and will necessarily evolve from the current “video chat” technology to a “data exchange platform,” enabling frequent virtual visits from physicians, combined with remote wearable devices and mobile apps that will share information gathered from sensors in real time including patient vital signs and patient-generated lab data.

Telemedicine will become “more and more enriched by the patient having data to review with the doctor,” according to Topol. At the same time, he contends that telehealth will not replace or replicate traditional patient office visits, adding that, “There will always be face-to-face office visits.”

Topol says that patients who are unable to physically see physicians in hospital or office setting are the ones who need telemedicine the most.

Towards that end, Dorsey—a neurologist—testified last week in support of telemedicine initiatives at a House Subcommittee on Commerce, Manufacturing, and Trade hearing. In particular, he told lawmakers that more than 40 percent of Medicare beneficiaries with Parkinson’s disease are currently not able to see a neurologist.

As a result, these patients are more likely to fracture their hip, be placed in a skilled nursing facility and die prematurely. However, according to Dorsey, simple video conferencing like Skype can enable clinicians to reach these kinds of patients in their homes.

“In a pilot study, these virtual house calls were feasible, provided comparable outcomes to in-person care, and saved patients and their caregivers three hours of time and 100 miles of travel,” he said. “With 18 centers, including Baylor, Northwestern, University of Kansas, and University of Florida, we are conducting the first national randomized controlled trial of virtual house calls for Parkinson’s disease. Demand for telehealth is high. Over 11,000 individuals from 80 countries and all 50 states visited the study’s website, and nearly 1,000 individuals with Parkinson’s disease wanted to participate in this 200-person study, which will complete this summer.”

However, Dorsey argued that the need for telemedicine goes beyond just technology but requires changes in Medicare policy that are major barriers to adoption. He pointed out that last year, Medicare spent less than one hundredth of one percent of its budget on telehealth.

“Currently, Medicare pays neurologists $150 to see a patient with Parkinson disease in a hospital-based clinic, $80 for a visit in a community-based clinic, and $0 to see a patient remotely in their home,” Dorsey said. “In essence, Medicare subsidizes institution-based care and dis-incents patient-centered care.”

Nonetheless, he asserted that legislation has been introduced that could fix these policies. Dorsey spoke in support of the TELEmedicine for MEDicare (TELE-MED) Act of 2015, which would permit Medicare providers licensed to practice physically in one state to treat patients electronically across state lines. Under the TELE-MED Act, a Medicare participating physician or practitioner would be able to provide services to a Medicare beneficiary across state lines without being licensed in that patient’s state as long as the provider is licensed or authorized to provide that service in their own state.

“The TELE-MED Act would enable any Medicare provider to care for any Medicare beneficiary,” according to Dorsey. “The Act mirrors how physicians in the Veterans’ Administration can care for any veteran anywhere in the U.S., and last year the VA provided over 2 million telehealth visits.

Likewise, he said the Medicare Telehealth Parity Act “would expand Medicare’s coverage of telehealth, which today reaches veterans, military personnel, Medicaid beneficiaries, and prisoners but largely excludes 50 million older Americans.”

The Medicare Telehealth Parity Act seeks to expand Medicare coverage and reimbursement of telemedicine services putting them on the path toward payment parity with in-person healthcare visits. Critics like Dorsey see Medicare restrictions on telehealth services as major policy barriers to greater use of the technology in healthcare, preventing patients and providers from taking advantage of advancements in telemedicine.

“Rather than subsidizing high-cost, institution-based care, Congress should incent potentially lower cost, patient-centered care delivered to where patients—not institutions—are,” concluded Dorsey.

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