There’s a Growing Trend towards Telemedicine in Primary Care

By Tom Giannulli, MD, MS, Chief Medical Information Officer, Kareo

Telemedicine is no new thing. Hospitals, specialists, and rural healthcare facilities have been using it for years. It has been used to improve access to specialty care and for consultations. But telemedicine is a little newer to the primary care market.

All of that is changing now. Telemedicine isn’t restricted to healthcare provider to healthcare provider interactions. Big computers and monitors aren’t required. Today, patients can have virtual appointments with providers using home computers and other devices.

According to the Deloitte Center for Health Solutions 2013 Survey of U.S. Physicians, 18% of primary care physicians use telemedicine for follow-up or diagnostic visits. They are able to do this using services that provide the platform to securely connect with patients.

Telemedicine used in this way may hold the key to improving access to care and outcomes. The New England Journal of Medicine reported in May 2013 that physicians in many specialties are starting to embrace telemedicine as a way to “expand their practice, reach new patients, and potentially improve the care of patients who have historically had poor access to medical services—especially specialty services.” The article, titled “Telemedicine: Changing the Landscape of Rural Physician Practice,” cites various examples of how providers, including a pediatric critical care physician, a psychiatrist, a neurologist who performs telestroke consultations, an OB/GYN, and a family medicine physician, are using the technology to improve care.

It seems that primary care providers are catching on to what those in some other specialties already knew. Cardiologists and electro-physiologists have embraced telemedicine because it allows them to monitor patients remotely, says Rhonda Bray, RN, BSN, founder and CEO of Rhythm Management Group, a Washington D.C.-based company that provides remote monitoring for patients with a pacemaker or implanted defibrillator. With remote cardiac monitoring, a machine collects data wirelessly and then transmits it to an EHR, or a company such as Rhythm Management Group sends the information to the provider within 24 hours.

Nearly one million Americans currently use remote cardiac monitoring, according to the American Telemedicine Association. Bray says physicians like the technology because it allows them to intervene more quickly. “If a patient has a new onset of a heart rhythm disturbance or their battery is wearing down or if the wires are failing, we can catch that early and alert the physician,” she says.

Patients like the technology as well because they’re able to stay at home while being monitored 24/7. “These devices are so sophisticated now that they’re on auto pilot. They self-adjust. There’s really no good clinical reason to bring patients in [to the office] every six months,” says Bray. According to a recent survey from Software Advice, among patients who have not used a telemedicine service, 75% express interest in using one in lieu of an in-person medical visit. Of the patients who have already tried telemedicine, 21% say the quality of care was similar to or higher than an in-person visit.

According to a recent report from Frost & Sullivan, telemedicine is going to grow substantially in the coming few years. They predict that by end of 2015 nearly six million homes worldwide will have some form tele-health set up in place, facilitated by newly launched services from major telecom providers.

And according to Richard Kimball, telemedicine can help “move to a fully capitated system where the doctors and hospitals get paid a fixed price for the entire healthcare provided to an individual or a population of individuals. If you are on the hook for the whole price, you’re going to be fully focused on how to keep the individual stable in their chronic condition and avoid acute events such as heart[s] attacks or foot amputations.”

If your practice is considering offering telemedicine services, there are some things to consider. Don’t jump in too fast shop around for a vendor and talk to references (about the vendor and how they have made telemedicine successful). Investigate reimbursement with your largest payers. Not all payers cover services or they only cover them for certain circumstances. However, if you are doing a direct pay, concierge, or hybrid model this can be a great add-on service that is included in the patient’s fee or paid for out of pocket. Consider the legal issues. The National Telehealth Policy Resource Center outlines several legal implications for telehealth that providers must address.

If after looking at these issues, you decide this is the right step for you then be sure to promote it and educate patients with a thorough marketing plan to make it a fully integrated part of your practice’s services.

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