In the last decade, rapid advances in medicine and technology has resulted in the use of new terms. Policymakers, healthcare systems, advocacy groups, and vendors may unknowingly use terms incorrectly when discussing medicine and technology. This is especially true when it comes to the terms, telemedicine and telehealth. Although the words are often used interchangeably, there is certainly a difference between the two.
Significantly, at the end of 2016 Congress unanimously approved legislation focused on emerging technology-enabled collaborative learning models. The new law directs HHS to assess these models and their ability to improve patient care and provider education, and to report its findings to Congress, along with recommendations for supporting their spread.
However, telemedicine also has a few downsides — by nature of its virtual interaction, and because of societal and technological barriers that could change in the future. The good news is, with the growing popularity and widespread acceptance of telemedicine, we’re likely to see the cons of telemedicine resolve themselves. With new technological advancements and shifting policy that increasingly supports telemedicine, we’re continuously finding ways to improve telemedicine and make it a viable, even advantageous form of healthcare delivery for many medical scenarios.
Like most technology solutions, telemedicine platforms usually require some training and equipment purchases. How much is really dependent on the solution – a more extensive inpatient telemedicine platform that will be used between primary doctors and consulting specialist may require more training and the purchase of a telemedicine cart and various mobile health devices. A secure videochat app like eVisit, requires much less staff training and usually only requires purchase of a webcam.
Obamacare—or the Affordable Care Act, as it is officially called—has been a catalyst for Teladoc’s recent growth surge. The law puts pressure on doctor’s offices, who are seeing more patients, as well as employers, who are looking to cut healthcare costs. As a result, telemedicine is becoming increasingly popular as a cheaper alternative to going to the emergency room. Insurance companies including Aetna (AET), Blue Shield of California and Oscar—which offers Obamacare plans on New York’s health exchange—have recently signed on with Teladoc, as have Home Depot (HD), T-Mobile (TMUS), pension giant CalPERS, and others.
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. This includes the above-mentioned non-clinical applications like administration and provider education which make telehealth the preferred modern terminology.
Teledermatology allows dermatology consultations over a distance using audio, visual and data communication, and has been found to improve efficiency. Applications comprise health care management such as diagnoses, consultation and treatment as well as (continuing medical) education. The dermatologists Perednia and Brown were the first to coin the term "teledermatology" in 1995. In a scientific publication, they described the value of a teledermatologic service in a rural area underserved by dermatologists.
Leading telemedicine companies like VSee, assists healthcare organizations in being able to treat patients with chronic diseases. They recognize that 75% of the United States healthcare spending is dedicated to treating heart disease, cancer, and diabetes. As a result, they’ve created telemedicine solutions that can keep physicians abreast from hospital to home. In addition, the patient, their family members, and other healthcare professionals can collaborate in the patient care process.
Type of telehealth. Medicare primarily only reimburses for live telemedicine, where the physician and patient are interacting in real-time through secure, videochat. This type of telemedicine visit is meant to substitute a face-to-face in-person visit. The only exception is in Hawaii and Alaska, where Medicare reimburses for store-and-forward telemedicine as well.
The future of telemedicine is wide open, with room for drastic improvement and more technology based medical care. As the world of tech continues to evolve, so too can the world of telehealth. Already, patients can sit down for a one on one appointment anywhere and anytime with the use of nothing more than a mobile phone. Imagine what new technology will bring in terms of holographic imaging, long distance x-ray, and more work in the field of ultrasounds.
34 states and the District of Columbia require that private insurers cover telehealth the same as they cover in-person services. Many other insurers cover at least some telehealth service--and many more have expressed interest in expanding their telehealth coverage. To find out if your insurance company covers telehealth services, please contact your benefits manager.
All the numbers point to the exponential growth of telemedicine – in other words, it’s not going anywhere. The global telemedicine market was worth $17.8 billion in 2014, and is projected to grow well beyond that by 2020. ATA President Dr. Reed Tuckson estimated that approximately 800,000 virtual consultations will take place in the U.S. in 2015. And health systems, doctors, legislators, and patients are fueling that upward trend. A recent survey found an incredible90% of healthcare executives were in the process of developing or implementing a telemedicine program, and 84% said these program were important. IHS projected the number of patients using telemedicine will rise from roughly 350,000 in 2013 to 7 million by 2018. And with this high demand for telemedicine, legislators are scrambling to pass bills that offer both support and needed regulations; in August 2015, Congress had 26 telemedicine-related bills waiting for decision.
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!
“For the most part, an interaction — whether in person, via telemedicine or on the phone — between a patient and a physician can be beneficial,” Downey wrote in a 2015 blog. “The sticking point is the issuance of a prescription medication to a previously unknown person who the doctor has never examined and for which the doctor has no access to the medical record. And here's where telemedicine differs from telehealth. During a telemedicine visit, the patient is seen by the provider. A patient presenter is with the patient in most cases, and follows the directions of the remote provider in placing a stethoscope or exam camera on the patient's body, providing both sounds and images. The remote provider also has the benefit of an array of other medical devices to gather patient information not available to a D2C telehealth physician.”
Up until 2013, hospitals were required to staff their EDs with a physician 24 hours a day, either on site or on call. In 2013, the Centers for Medicare & Medicaid Services adjusted that requirement to allow rural hospitals to use advanced practice providers, such as a physician assistants and nurse practitioners, as long as physicians could be summoned via telemedicine in an emergency.
“It is less about the technology as it is about delivering medicine via a new medium,” Clement explained. “Luckily, the C-suite is accustomed now to teleconferencing, so they have a feel for the benefits, as well as some of the communication struggles that come with being audio-visual from remote locations. Much like teleconferencing, there are situations where telemedicine will fit and others where it will not: It can’t be looked upon as a silver bullet.”
This open, multidirectional sharing of knowledge and expertise creates new local capacity that didn't previously exist to treat devastating conditions like opioid addiction, rheumatoid arthritis, heart disease, HIV and hepatitis. In New Mexico, for example, the number of providers certified to treat opioid use disorder with buprenorphine has increased more than tenfold—from 36 in 2005 to 375 in 2014—following the launch of an ECHO for treating addiction.
Once shared, that knowledge takes on a life of its own, growing and moving in all directions. Primary-care clinicians learn from their specialist mentors at the university hubs, but they also learn from each other. And by applying the knowledge they gain in the field, they produce new knowledge, which they then relay to their specialist and primary-care colleagues in their learning community.
How much and which telemedicine services private payers pay for again can vary widely by state. While the trend is toward broader coverage of telemedicine services for plan enrollees, private payers are still deciding on exactly what they will cover and what they won’t. 29 states and Washington, DC have passed telemedicine parity laws, which mandate that private payers in those states pay for telemedicine services at the same rate as in-person visits.
Online medical care might not be the doctors and nurses of your parents’ time, but it is a huge advancement that will help care for your parents’ future. Geriatric care is greatly impacted by the mobility of older patients and using technology-based doctor appointments is a much-needed solution. So, is this new-fangled approach to healthcare here to stay? It sure looks that way!
There are many new medical tech terms being used today that the average patient may not be familiar with. For example, a common misunderstanding is that the terms telemedicine, telecare, and telehealth are interchangeable. The truth is that each of these terms refers to a different way of administering health care via existing technologies or a different area of medical technology. To clarify the subtle differences between these three terms, we have provided a detailed definition of each.
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.
A native of rural Washington, Katie Gieseke has practiced medicine since 2009, and provided virtual care since 2015. She received her undergraduate degree in Nursing from the University of Portland and received her Doctorate of Nursing Practice and Family Nurse Practitioner certification from the University of Washington. Her nursing career ranges from experience in the emergency department to home health assessments. During her time in the emergency department, she became interested in improving the effectiveness, efficiency and continuity of the health care system. She has a strong interest in illness prevention and look forward to having the time to spend with patients providing education on maintaining wellness, disease prevention and motivating patients to take control of their health.