Patients seem to like virtual visits and many physician leaders have been blazing trails and persuading peers to follow. But why do some health care providers remain reluctant?
Even as some health care providers still hesitate to embrace telemedicine, other leaders have been blazing trails and persuading peers to follow.
Among them is Morgan Waller, MBA, BSN, RN, director of telemedicine at Children’s Mercy Kansas City. The 354-bed hospital owns three regional health care centers that host multi-specialty telemedicine clinics in three smaller communities—Joplin and Joseph, Missouri, and Wichita, Kansas—that have limited or no access to on-site pediatric specialists. A fourth telemedicine clinic—in Junction City, Kansas—is slated to open by the end of 2017.
“We have specialized digital exam devices and specially trained RN facilitators who can do a complete head-to-toe-and-beyond exam,” says Waller, who has been a strong advocate of telemedicine since the program began five years ago.
With these high-definition magnifying devices, providers can examine the skin, eyes, ears, nose and throat and then show parents and children where an infection lies or how a surgical incision is healing. “It allows in some ways better education and better information for the patients even though it’s virtual,” Waller says.
The cost of technology continues to go down. It continues to improve. It continues to become more efficient.
Dr. Vimal Mishra, VCU telemedicine office medical director
The hospital offers telemedicine in 26 of its 47 pediatric specialties. Families throughout Kansas and Missouri can access a specialist without traveling hours to a larger metropolitan area. Each month, about 150 children use the telemedicine clinics, and Waller expects the demand to accelerate this year.
Last September, Waller and her colleagues published a study in Annals of Allergy, Asthma & Immunology, which demonstrated that telemedicine is as effective as in-person checkups in managing asthmatic patients. The study initially enrolled 169 children residing in two remote locations and presented them with the option of an in-person visit or a telemedicine session at a local clinic.
Of the participants, 100 were seen in-person and 69 via telemedicine. A total of 34 in-person and 40 telemedicine patients completed all three visits during the six-month study. Everyone experienced a small, although statistically insignificant, improvement in asthma control over time. “Telemedicine was [not inferior] to in-person visits,” and most telemedicine group subjects were satisfied with the virtual encounters, the study concluded.
In many cases, convenience makes telemedicine a win-win for providers and patients as the real-time interaction of high-definition video and audio communication facilitates diagnosis and treatment, said Vimal Mishra, MD, MMCi, medical director of the telemedicine office and an assistant professor in the hospital medicine division at Virginia Commonwealth University. For more than 20 years, the program has provided medical consultations to a wide variety of patients, including the prison population in about 30 facilities under the state’s department of corrections.
“The cost of technology continues to go down,” says Mishra, a physician informaticist, citing the emergence of innovations. “It continues to improve. It continues to become more efficient.”
Another advantage lies in telemedicine platforms’ capabilities to manage “different disease spectrums.”
Physicians wavering on telemedicine wonder if insurers compensate adequately for these services, says Ronald S. Weinstein, MD, FCAP, founder and director of the telemedicine program at the University of Arizona College of Medicine in Tucson. Since 1996, the statewide program has done telemedicine consultations in more than 60 subspecialties and handled 1.4 million cases.
Telemedicine parity laws exist in 34 states. In addition, two states have a partial parity law applying to only some specialties, while four states are considering legislation, according to the American Telemedicine Association (updated June 2018).
“The larger challenge is Medicare,” said Weinstein, president-emeritus of the association. “Medicare reimburses poorly for telemedicine. It literally takes an act of Congress to get additional billing codes. The process is tortuous.”
Despite these hurdles, Weinstein expects the field to make progress in attracting more providers as they recognize the benefits. For instance, during the onset of a stroke, telemedicine can be a lifesaver, ensuring the “very high level of diagnostic accuracy” required to initiate timely treatment before major brain damage occurs.
“Networks are forming all over the country to provide telestroke services,” says Weinstein, who first became involved in telemedicine at Massachusetts General Hospital in 1968. “This then becomes a driver for expanding telemedicine services.”
Telemedicine also can bridge a crucial care gap until transport to a trauma center arrives, says James Marcin, MD, MPH, a professor of pediatric critical care at the University of California-Davis Children’s Hospital in Sacramento. In pediatrics, telemedicine serves a particularly important purpose because children’s hospitals tend to be rare in most regions.
Since 2002, the hospital’s telemedicine program has helped lessen the disparities in care between urban and rural residents in areas where specialists aren’t readily available. The interactive sessions also help pediatricians better manage their patients’ illnesses.
“We use the technology to make ourselves virtually available, so it raises the bar from what they have currently,” Marcin says.
Susan Kreimer is a freelance health care writer based in New York.