“Our executive leadership have been strong supporters of telemedicine at UPMC for more than a decade,” said Sokolovich of the University of Pittsburgh Medical Center. “With the initial success of tele-stroke and tele-behavioral health services, leadership recognizes the potential of telehealth in implementing new models of care that enhance the patient experience, support access to quality care regardless of geographic location, and maximize efficiencies.”
In 2014, the government of Luxembourg, along with satellite operator, SES and NGOs, Archemed, Fondation Follereau, Friendship Luxembourg, German Doctors and Médecins Sans Frontières, established SATMED, a multilayer eHealth platform to improve public health in remote areas of emerging and developing countries, using the Emergency.lu disaster relief satellite platform and the Astra 2G TV satellite.[93] SATMED was first deployed in response to a report in 2014 by German Doctors of poor communications in Sierra Leone hampering the fight against Ebola, and SATMED equipment arrived in the Serabu clinic in Sierra Leone in December 2014.[94] In June 2015 SATMED was deployed at Maternité Hospital in Ahozonnoude, Benin to provide remote consultation and monitoring, and is the only effective communication link between Ahozonnoude, the capital and a third hospital in Allada, since land routes are often inaccessible due to flooding during the rainy season.[95][96]
Additionally, Medicare will only pay for telemedicine services when the patient is located in a Health Professional Shortage Area and receives care from an eligible provider. The medical service itself also has to fall under one of thesecovered CPT/HCPCS codes. When all these conditions are met, Medicare pays for 80% of the physician fee (other 20% is paid by the patient) and will additionally pay a facility fee to the originating site.
VSee urges organizations to try their free app so physicians can get a feel for sharing medical documents and streaming digital device images. In addition, organizations should ensure they have compatible microphones, webcams, speakers, and more. A telemedicine tech should be identified within the practice to help others get acclimated and resolve tech issues. Also, practices should be aware of their Internet connection. VSee’s video chat is robust, but how well it works comes down to the Internet connection and computer capabilities.
Telehealth is sometimes discussed interchangeably with telemedicine. The Health Resources and Services Administration distinguishes telehealth from telemedicine in its scope. According to them, telemedicine only describes remote clinical services; such as diagnosis and monitoring, while telehealth includes preventative, promotive and curative care delivery.[1] This includes the above-mentioned non-clinical applications like administration and provider education which make telehealth the preferred modern terminology.[2]

Telehealth has emerged as a critical tool in providing health care services. [1] The practice covers a broad range of medical technology and services that collectively define the discipline. Telehealth is especially beneficial for patients who live in rural communities and other remote areas where medical professionals use the Internet to gather and share information as well as monitor the health conditions of patients by using peripheral equipment and software such as video conferencing devices, store-and-forward imaging, and streaming media. The following information details important factors that are shaping this burgeoning field.


Doctor On Demand operates subject to state laws. As of August 2017, Doctor On Demand offers behavioral healthcare in all states where Mental Health services are available to Doctor On Demand’s patient population at large, and Medical care in all 50 states and the District of Columbia. Doctor On Demand is not intended to replace an annual, in-person visit with a primary care physician.** Doctor On Demand physicians do not prescribe Controlled Substances, and may elect not to treat or prescribe other medications based on what is clinically appropriate.

In layman’s language, telemedicine and telehealth are terms that represent the transfer and exchange of medical information between different sites. From the American Telemedicine Association’s point of view; telemedicine, as well as telehealth, are all about transmission of still images, patient’s consultations through video conferencing, patient portals, remote control and monitoring of vital signs, continuing medical education, patient-focused wireless applications and nursing call centers and many other applications.
^ Kontaxakis, George; Visvikis, Dimitris; Ohl, Roland; Sachpazidis, Ilias; Suarez, Juan; Selby, Peter; Cheze-Le Rest, Catherine; Santos, Andres; Ortega, Fernando; Diaz, Javier; Pan, Leyun; Strauss, Ludwig; Dimitrakopoulou-Strauss, Antonia; Sakas, Georgios; Pozo, Miguel (2006). "Integrated telemedicine applications and services for oncological positron emission tomography". Oncology Reports. doi:10.3892/or.15.4.1091.
A company’s culture is defined by the behavior that is allowed. The Board, CEO and the management team need to set the example—allowing toxic, demoralizing, untrustworthy actions to persist is implicitly endorsing that behavior. Look to the past for what’s likely to come—every leader in the company has brought former colleagues to work alongside them at DOD except for one. Red flag. This leader burns bridges. Act before...

Telehealth Reimbursement Medicaid: According to Chiron Health, Medicaid systems in 48 states will reimburse for telehealth provided via live video systems while 19 state Medicaid programs will pay for RPM. 12 state programs will finance store and forward telehealth and seven states allow payment for all three telehealth categories. But even though Medicaid is more accommodating of telehealth than Medicare, rules governing payment through state Medicaid programs vary considerably. For instance, some states require patients to be in a medical facility and not at home while receiving telehealth care, and others require a licensed provider to be co-located with patients while they are receiving telehealth services.
Telehealth, the use of electronic communication to remotely provide health care information and services, is gaining more and more attention as providers, patients, and payers all seek more effective and cost-efficient ways to deliver care. Physical therapy is no exception, and while those services have developed mostly in rural areas to accommodate the long distances between patients and providers, telehealth in physical therapy is being considered in other geographic and clinical settings.
Remote patient monitoring, which is sometimes called self-monitoring or self-testing, is a means of monitoring patient health and clinical information at a distance. It helps to simplify patient compliance with testing and it lowers the cost of frequent monitoring. It is frequently used in the treatment and management of chronic illnesses like asthma, cardiovascular disease, and diabetes.

In the United States, the major companies offering primary care for non-acute illnesses include Teladoc, American Well, and PlushCare.[81] Companies such as Grand Rounds offer remote access to specialty care.[82] Additionally, telemedicine companies are collaborating with health insurers and other telemedicine providers to expand marketshare and patient access to telemedicine consultations. For example, In 2015, UnitedHealthcare announced that it would cover a range of video visits from Doctor On Demand, American Well's AmWell, and its own Optum's NowClinic, which is a white-labeled American Well offering.[83][84] On November 30, 2017, PlushCare launched in some U.S. states, the Pre-Exposure Prophylaxis (PrEP) therapy for prevention of HIV. In this PrEP initiative, PlushCare does not require an initial check-up and provides consistent online doctor visits, regular local laboratory testing and prescriptions filled at partner pharmacies.[85][86][87]


A telemedicine vendor should have no reservations in signing a Business Associate Agreement. Those that do sign one are confident in their ability to securely store patient information. VSee is currently the only company that offers a HIPAA Messenger App for organizations to try for free. They are confident that their telemedicine solutions can protect pertinent patient information.

As of 2015, Teladoc was the only telemedicine company to be publicly traded on the New York Stock Exchange. In December 2016, the American Hospital Association exclusively endorsed Teladoc's telehealth technology platform. Teladoc now operates its full suite of services 24 hours a day, 365 days a year, by web, phone, or mobile app in 48 of the 50 states.[7]

An example of these limitations include the current American reimbursement infrastructure, where Medicare will reimburse for telehealth services only when a patient is living in an area where specialists are in shortage, or in particular rural counties. The area is defined by whether it is a medical facility as opposed to a patient's' home. The site that the practitioner is in, however, is unrestricted. Medicare will only reimburse live video (synchronous) type services, not store-and-forward, mhealth or remote patient monitoring (if it does not involve live-video). Some insurers currently will reimburse telehealth, but not all yet. So providers and patients must go to the extra effort of finding the correct insurers before continuing. Again in America, states generally tend to require that clinicians are licensed to practice in the surgery' state, therefore they can only provide their service if licensed in an area that they do not live in themselves.[1]
Telehealth Reimbursement Medicaid: According to Chiron Health, Medicaid systems in 48 states will reimburse for telehealth provided via live video systems while 19 state Medicaid programs will pay for RPM. 12 state programs will finance store and forward telehealth and seven states allow payment for all three telehealth categories. But even though Medicaid is more accommodating of telehealth than Medicare, rules governing payment through state Medicaid programs vary considerably. For instance, some states require patients to be in a medical facility and not at home while receiving telehealth care, and others require a licensed provider to be co-located with patients while they are receiving telehealth services.
In the early days of telemedicine, health professionals used the burgeoning technology as a way to reach patients living in rural areas. However, the technology quickly expanded into urban areas, especially those that suffered from healthcare shortages. In 1967, physicians at the University of Miami School of Medicine and Miami's Fire Department transmitted electrocardiographic rhythms over existing voice radio channels from fire-rescue units to the city's Jackson Memorial Hospital.
There are a variety of payment models to fund telemedicine services. For example, some health systems offer telemedicine consultations as part of their regular care services, and payers charge patients based on insurance plans or government reimbursement schedules. In other cases, a patient's employer offers virtual care options as part of health insurance coverage premiums. Some people may opt to independently use a telemedicine vendor for a flat fee.
According to a May 2017 article by Alignment Chief Medical Officer Ken Kim, the organization’s efforts paid off. “Because of the program, Alignment’s seniors are seeing reduced 30-day readmission rates … compared to the national Medicare average readmission rate of about 18%. In 2016, Alignment members enrolled in remote [monitoring] across all markets saw hospital readmission rates of 7.2%.”
Teladoc (NYSE:TDOC) is the global leader in virtual care. A mission-driven organization, the company is successfully modernizing how people access and experience healthcare, with a focus on high quality, lower costs, and improved outcomes around the world. The company’s award-winning, integrated clinical solutions are inclusive of telehealth, expert medical opinions, AI and analytics, and licensable platform services. With more than 2,000 employees, the organization delivers care in 125 countries and in more than 20 languages, partnering with employers, hospitals and health systems, and insurers to transform care delivery.
Telecare is the term that relates to technology that enables patients to maintain their independence and safety while remaining in their own homes. This technology includes mobile monitoring devices, medical alert systems, and telecommunications technology like computers and telephones. Continuous remote monitoring of patients enables telecare to track lifestyle changes over time as well as receiving alerts relating to real-time emergencies.
Doctor on Demand is currently available for patients in 15 states, including large states like California, Florida, New Jersey, New York, Ohio, and Texas. The company has more than 1,000 doctors available for video consultants one or two days a week, according to Bloomberg Businessweek. The company trains physicians on how to use the service, and covers other logistics like patient questionnaires and malpractice insurance.
Remote surgery (also known as telesurgery) is the ability for a doctor to perform surgery on a patient even though they are not physically in the same location. It is a form of telepresence. Remote surgery combines elements of robotics, cutting edge communication technology such as high-speed data connections, haptics and elements of management information systems. While the field of robotic surgery is fairly well established, most of these robots are controlled by surgeons at the location of the surgery.
Telehealth allows multiple, different disciplines to merge and deliver a much more uniform level of care using the efficiency and accessibility of everyday technology. As telehealth proliferates mainstream healthcare and challenges notions of traditional healthcare delivery, different populations are starting to experience better quality, access and personalised care in their lives.[22][23]

Also impacting the rise of telemedicine today is the growing mobile health field. With the wide variety of mobile health apps and new mobile medical devices that are consumer-friendly, patients are starting to use technology to monitor and track their health. Simple home-use medical devices that can take vitals and diagnose ear infections, monitor glucose levels, or measure blood pressure let patients gather needed medical information for a doctor’s diagnosis, without going into the doctor’s office. And again, as more patients get proactive about using technology to manage their health, they also will be more open to alternative ways to get care – through telemedicine!
As a caregiver for a loved one, you have enough to worry about. That’s why Teladoc® gives you a convenient and affordable way to provide care, letting you arrange a 2- or 3-way video or phone visit with a licensed doctor 24/7 for just $45/visit. Add the individual you care for to your Teladoc® account, even if they’re not covered by your health plan.
The laws regarding reimbursements change regularly as more service providers incorporate telehealth technology into their practices. Reimbursement procedures can vary by state, practice, insurer, and service. [3] Care providers need to understand several facts, regulations, and laws to navigate Medicare telehealth reimbursements. They must first scrutinize whether the distance between the facility (the originating site) and the patient is far enough to qualify as a distant site. The location must also qualify as a Health Professional Shortage Area (HPSA) per Medicare guidelines. Additionally, the originating site must fall under Medicare’s classification as a legally authorized private practice, hospital, or critical access hospital (CAH). For instance, the Centers for Medicare and Medicaid Services ranks the Harvard Street Neighborhood Health Center as a top facility in need of physician services based on these criteria. Care providers must also use proper insurance coding to be reimbursed for hosting services that use telehealth technologies. For now, collecting reimbursements for telehealth services remains simpler for practitioners who limit the scope to which they apply the technology.
In addition to the parity laws, some states require providers to obtain patient consent before using telehealth services. Failure to obtain patient consent may result in physicians not being paid. Providers also have to be aware that while some states do not legally require consent, if they bill telemedicine through Medicaid, they will need written consent.
In the early days, telemedicine was used mostly to connect doctors working with a patient in one location to specialists somewhere else. This was of great benefit to rural or hard to reach populations where specialists aren’t readily available. Throughout the next several decades, the equipment necessary to conduct remote visits remained expensive and complex, so the use of the approach, while growing, was limited.
The company has made seven acquisitions: Consult A Doctor for $16.6 million cash in August 2013; AmeriDoc for $17.2 million in May 2014; and BetterHelp for $3.5 million in cash and a $1.0 million promissory note in January 2015.[23] The company also announced and closed the acquisition of HealthiestYou in July 2016.[23] Stat Health Services, Inc. (StatDoc) for $30.1 million, $13.3 million of cash and $16.8 million of Teladoc common stock (or 1,051,033 shares), net of cash acquired in June 2015[27] ; and HealthiestYou for $45 million in cash and 6.96 million shares of Teladoc's common stock in June 2016.[28] In 2017, the company purchased Best Doctors, Inc., a provider of medical second opinions and a "pay-to-play" medical award listing.[29] Most recently, Teladoc has acquired Advance Medical for $352 million. Advance Medical is a telemedicine company which has locations in Chile, Spain, and parts of Asia. It runs a virtual doctor service, called Global Care on Demand, which offers access to medical advice by phone or video by doctors located in eight main hubs around the world who speak more than 20 languages, and is targeted at expatriates.[30]
As with many other aspects of modern life, new technologies have had profound impacts on the healthcare delivery system in the US. Modern healthcare customers think nothing of booking an appointment, requesting a prescription refill, or looking at test results online. Many of us count our steps, keep track of what we eat, and monitor our heart rate from a smart device. These days, healthcare and technology go hand in hand.

Patient Exam Cameras – These cameras are used to examine the patient’s overall condition. The different types of patient exam cameras are handheld cameras, camcorders, gooseneck cameras and those which may be placed above the set-top units. Analog and digital cameras are available and the ones that should be used depend on the connection to the set-top unit.
All the doctors in Teladoc's national network are U.S. board-certified family practitioners, primary care physicians, pediatricians and internists who use Electronic Health Records to diagnose, treat and write prescriptions when necessary. When accessing Teladoc, you'll be connected to a doctor in your state. These doctors are all actively practicing physicians and choose to incorporate telemedicine into their medical practice as a way to offer more affordable, convenient access to quality care.
Teleophthalmology is a branch of telemedicine that delivers eye care through digital medical equipment and telecommunications technology. Today, applications of teleophthalmology encompass access to eye specialists for patients in remote areas, ophthalmic disease screening, diagnosis and monitoring; as well as distant learning. Teleophthalmology may help reduce disparities by providing remote, low-cost screening tests such as diabetic retinopathy screening to low-income and uninsured patients.[75][76] In Mizoram, India, a hilly area with poor roads, between 2011 till 2015, Tele-ophthalmology has provided care to over 10000 patients. These patients were examined by ophthalmic assistants locally but surgery was done on appointment after viewing the patient images online by Eye Surgeons in the hospital 6–12 hours away. Instead of an average 5 trips for say, a cataract procedure, only one was required for surgery alone as even post op care like stitch removal and glasses was done locally. There were huge cost savings in travel etc.[77]

Founded only eight months ago, Doctor On Demand has gained rapid visibility thanks to its founders, television personality Dr. Phil and his son Jay McGraw who produces The Doctors, a health talk show where viewers can submit questions to a small stable of doctors. The McGraws flog the service on their shows to millions of mostly young women who are not necessarily aware that the McGraws are stakeholders, since disclosure appears with the credit roll. (Rival Dr. Oz who’s an investor in health and wellness platform Sharecare also uses his show to publicize that start-up).
One of the key advantages of telemedicine is the ability to provide healthcare to a patient, no matter the patient or provider’s location. However, since providers are licensed to practice in a specific state, they are only legally allowed to offer telemedicine services to patients in the same state. Currently, 49 state medical boards require physicians practicing telemedicine to be licensed in the state where the patient is located.

In 2016, researchers posing as patients turned to 16 different telemedicine apps to diagnose skin issues. The results? Some of the online doctors misdiagnosed conditions like syphilis, others prescribed unnecessary meds, and two of the sites used doctors who aren't licensed to practice in the state the patient was located. The authors concluded that these apps repeatedly missed diagnoses by failing to ask simple, relevant questions.
Telehealth Reimbursement Medicare: Medicare, which finances care for patients who can most benefit from telehealth, will only pay if the originating site (service location of the patient) is either in a non-Metropolitan Statistical Area (MSA) or a Health Professional Shortage Area (HPSA). Medicare also limits the types of providers and facilities that can provide telehealth services. For more information, the Telehealth Resource Center (TRC) has furnished lists of covered providers, sites, and services.
Telemedicine is an important and quickly growing component of healthcare delievery in the United States.  There are currently about 200 telemedicine networks, with 3,500 service sites in the US.  In 2011 alone the Veterans Health Administration delivered over 300,000 remote consultations using telemedicine. More than half of all U.S. hospitals now use some form of telemedicine.

Reimbursement for Medicaid covered services, including those with telemedicine applications, must satisfy federal requirements of efficiency, economy and quality of care. States are encouraged to use the flexibility inherent in federal law to create innovative payment methodologies for services that incorporate telemedicine technology. For example, states may reimburse the physician or other licensed practitioner at the distant site and reimburse a facility fee to the originating site. States can also reimburse any additional costs such as technical support, transmission charges, and equipment. These add-on costs can be incorporated into the fee-for-service rates or separately reimbursed as an administrative cost by the state. If they are separately billed and reimbursed, the costs must be linked to a covered Medicaid service.
Dr. Bernstein has practiced medicine since 1990 and provided virtual care with our team since 2006. He received his medical degree from the University of North Carolina and completed a residency at Providence Family Practice in Seattle. He also holds a Master's Degree in Public Health from the University of Washington. Dr. Bernstein is dedicated to quality preventive medicine, public health promotion, and research. As Director of Clinical Quality, he manages the development and maintenance of the clinical standards of patient care, working with the development team to create new systems for measuring clinical delivery effectiveness. In his spare time, he is an avid cyclist and a soccer fan.
×