Did your state get a good grade? Thanks to the American Telemedicine Association, you can now find out. The ATA is out with a new report that awards “grades” in its “50 State Telemedicine Gaps Analysis.” In recent days, Gov.
On Monday, the American Telemedicine Association released two state policy reports on telemedicine that identify shortfalls in practices nationwide, FierceHealthIT reports.
States were assigned letter grades -- A through F -- based on their telemedicine policies.
Details of Coverage, Reimbursement Report
One report analyzed coverage and reimbursement standards (Dvorak, FierceHealthIT, 9/9).
Overall, seven states scored an A for payment and service delivery policies that support adoption of telemedicine:
Virginia (Pedulli, Clinical Innovation & Technology, 9/10).
Connecticut, Iowa and Rhode Island had the most significant barriers to advancing telehealth and scored the lowest in the report (FierceHealthIT, 9/9).
The report found that 21 states have telehealth parity laws for private insurance, but 29 states received a failing grade for having no such law in place.
Meanwhile, the report found that 47 state Medicaid programs at least partly covered telemedicine (ATA report , 9/8).
Details of Physician Practice Standards, Licensure Report
The second report analyzed and compared physician practice standards and licensure regulations for telemedicine.
The report found that for practice standards:
23 states received an A; and
1 state -- North Dakota -- received a failing grade (FierceHealthIT, 9/9).
The report noted that the results indicate "telemedicine utilization had been met with a mix of strides and stagnation in state-based policy" (ATA report , 9/8).
Meanwhile, no state received an A for interstate licensure policies for telemedicine, likely because of other restrictive policies that hinder practicing medicine across state lines, according toFierceHealthIT (FierceHealthIT, 9/9).
In a release, ATA CEO Jonathan Linkous said, "We hope these reports serve a dual purpose: to showcase the states that are doing an excellent job when it comes to telemedicine and to serve as a wake-up call to those who are failing to extend quality and affordable care to the residents of their state."
He added, "We hope that states will respond by streamlining policies to improve medical practice rules, licensure, health care quality and reduce costs through accelerated telemedicine adoption"
The Coastal Carolina Neuropsychiatric Center began offering telemedicine and telepsychiatry services in 2010, according to JDNews. It’s a type of two-way video conference over a secure line where a doctor can assess a patient from a remote location.
It’s no secret that the healthcare space is broken. A 2013 study conducted by the Journal of Patient Safety estimates that between 210,000 and 440,000 patients die in the US each year from accidental practice. To put this into perspective, an estimated 600,000 Americans die from heart disease each year and another 565,000 from cancer (source: www.cdc.gov), which puts healthcare incompetence as the third leading cause of death in the United States.
The pool of entrepreneurs in the race to offer mobile health consulting is growing larger by the day. With telemedicine, users have the power of accessibility in their hands with apps such as TouchCare and iBluebutton (see below). While the concept of telemedicine isn’t anything new, having the accessibility to one’s doctor is. Here are seven ways telemedicine changes the healthcare landscape—for the better:
1. Stronger relationships. Relationships are everything. If there was ever a person not to make angry, it’s your doctor. More important, your relationship with your doctor is everything, which is why mobile healthcare is so ideal. It offers the luxuries of personalization and convenience without exposing yourself or your child to the 15 other sickly patients normally waiting in your doctor’s office.
2. Convenience. TouchCare takes mobile healthcare to the next level as it creates an entirely new user experience for the customer. Rather than having to trek into the doctor’s office for a consult, you can now do so from the comfort of your own smartphone for follow up visits, after hours calls, or while traveling. Additionally, parents gain a stronger piece of mind because they can immediately reach their doctor for relatively benign symptoms such as a cough or runny nose.
3. Reduced complexity. Complexity is defined by the speed at which industries change and the interdependence of relationships therein. Telemedicine reduces both.
A medical record folder being pulled from the records (Photo credit: Wikipedia)
4. Greater awareness. iBlueButton is perhaps the most comprehensive app for telemedicine as it allows users (currently only for active duty military and veterans) to carry their own medical records with them in their smartphone. For physicians, pop-up windows alert the provider of possible medication side effects for greater drug reconciliation.
5. Shared purpose. The focus of healthcare today appears to be more towards earning a profit rather than serving its purpose of patient care. The purpose of an organization is (ideally) to serve as a value differentiator to its customers because of what they (the company) stand for. Whatever a company’s flavor, its purpose is defined by a certifiable element that distinguishes it from all else, and that element is what attains and retains customers and fulfills a societal need. Bettina Experton, MD, MPH, and President & CEO of Humetrix, which is the company behind iBluebutton, believes that “collaborating for a higher purpose is a key corporate value… We work to empower patients and make them more informed healthcare consumers, and we think about ways to make life easier for parents, caregivers and families in an increasingly complex healthcare environment.” (source: http://www.ibluebutton.com/post-be-16/).
6. Improved efficiency. Smaller practices get bought out by larger organizations, which means new regulations and more bureaucracy are added into their daily routine. Nancy Zimmerman, head of Marketing for TouchCare, cited one practice in North Carolina who was recently bought out by a larger company who needed to scale back from seeing their normal 60 patients per day to 20 due to the added bureaucracy. Telemedicine eliminates phone consults and the addiction to answering emails.
7. Enhanced flexibility for physician. The immediacy of telemedicine provides direct access to the customer. iBlueButton users can directly share critical parts of their medical record with their doctor via secure messaging.
The changing landscape of healthcare offered through smartphone apps allows doctors to build stronger relationships with their patients rather than be just another MD—critical to the “patient” component of “patient care.”
According to a new market report published by Transparency Market Research “Telemedicine Market [Specialty (Cardiology, Dermatology, Neurology, Orthopedics, Emergency Care, Internal Medicine, Gynecology, and Others) and Services (Tele-Consultation, Tele-Monitoring, Tele-Education, Tele-Training, Tele-Care, and Tele-Surgery)] – Global Industry Analysis, Size, Share, Growth, Trends and Forecast, 2014 – 2020,” the global telemedicine market was valued at USD 14.3 billion in 2013 and is expected to grow at a CAGR of 14.3% in the forecast period from 2014 to 2020, to reach an estimated value of USD 36.3 billion in 2020.
As a group, about 35 percent of baby boomers were interested in using their smartphone to learn about and better manage their own health, according to results from a survey conducted by academic researchers in late 2010. The survey, which consisted of responses from 469 consumers, 258 of which are baby boomers, only published its findings this month.
Looking over the year’s telemedicine deals, it seems like investors are hedging their bets. Although tools supported by employer plans have dominated, direct to consumer models are proving attractive too, as have more specialized business to business services. I spoke with a handful of investors to get their perspectives.
Based on their feedback, the consensus is with business to business to consumer solutions demonstrated by companies like TelaDoc and MD Live. Telemedicine provided through employer wellness funds makes sense to investors. It offers a way for employers to save money on unnecessary emergency room visits. Staff can access these video consults either through kiosks àla HealthSpot or from a smartphone or computer without missing work. But it’s the future that’s intriguing.
Some factors that could swing the balance in the coming years rest on the physicians’ comfort level with this technology. Along with the ability to attract and keep more board certified physicians or successfully get reimbursement, how does the physician come across to the patient on the other side of the computer, mobile device, etc? Are they smiling? Are they comfortable with the technology? How effective are they at directing patients or another medical professional with the patient in using bluetooth devices to get specific readings? How is data from the session integrated into the patient’s EHR?
There have also been some barriers impeding growth. Ezra Mehlman of Health Enterprise Partners pointed out that the inability to grow small businesses has historically posed a big barrier to entry in the market. “Regulations that impede interstate consults have made it very complicated for small businesses to grow, although the regulatory environment has been changing. Also, it’s hard for companies to pay physicians enough to take video calls from home and a lack of a compelling revenue models to interest physicians.”
Here is an overview of some of the telemedicine models and services that investors highlighted
“B2b models such as Teladoc and MD Live have rightly attracted considerable attention. However, the increasingly “retailization” of the market via high deductible plans, HSAs, defined contribution, and generational shifts, should increasingly change this dynamic and we will see more individuals optimizing for convenience and access outside of the context of their insurance provider’s network as a means to moderate costs.”
Health Enterprise Partners, Ezra Mehlman, vice president
“The data we have seen suggests that when a company plan, self-insured employer or hospital is picking up the bill, utilization [of telemedicine] is higher…I think there is a higher willingness for patients to use the service when it is no skin off their back.”
Direct to consumer
Skip Fleshman, Asset Management Ventures partner supports this model as a backer of HealthTap. Factors like the caliber of doctors it has been able to attract is a significant point going in its favor, said Fleshman. “Where the rubber meets the road is what kind of physicians will you attract? That is where models like HealthTap make more sense.”
And yet, he wonders how much consumers will be willing to pay from their own pocket. Although some companies have focused on providing second opinions for diagnoses that require surgery or a complex treatment regimen like cancer, Fleshman says most people trust their doctors.
Coppedge: “In the long run as attitudes shift and individuals become more accountable for their own health (the analogy would be a car owner being responsible for their own maintenance) we think we will see some big winners emerge in the D to C space, at least for primary and urgent care. This trend may be accelerated in places like New York City, San Francisco, Los Angeles, Seattle, and Portland but it may take five to 15 years for most of the country,” he said. “The winners when the D to C opportunity really emerges may not be the high-profile venture-backed companies making headlines today but rather the folks who already have strong consumer healthcare brands like Walgreens, CVS, Walmart, WebMd, J&J and the some of the leading and well-regarded health systems.”
Mehlman said the direct to consumer space makes sense as part of a concierge service for primary care and may prove an attractive option as consumers face higher deductables. On the other hand, it depends on how they value the perceived benefit from this service. Would they prefer to spend their money on healthcare or allocate it on sexier options?
Telepsychiatry and teledermatology are a couple of examples of telemedicine specialties that have gained more acceptance. These companies are split between services offered to and through providers and direct to consumers. 1DocWay provides its telepsychiatry service through psychiatric hospitals supported by physician networks and works within the reimbursement parameters of Medicare and Medicaid. Teledermatology companies such as Iagnosis’ Dermatologists on Call have relied more on the direct to consumer market. In addition to the convenience factor, embarrassment is a strong motivator for this care delivery approach, particularly when it involves a rash associated with a sexually transmitted disease.
Another area where telemedicine is provided through a hospital is interpretation services for non-English speakers. Mehlman pointed to InDemand Interpreting, a company backed by Health Enterprise Partners. Interpreters work from video call centers and offer services in more than 13 languages and signing for deaf patients.
Provider based solutions Hospitals and health systems such as University of Pittsburgh Medical Center and Mayo Clinic are offering video consults with patients. Although the consensus is that it’s early days to determine how successful this approach will be, it raises some interesting questions about the directions it will take, such as specialty areas. Several institutions are already providing telemedicine services to other hospitals through teleICU and telestroke. It also will be interesting to see whether patients put more trust in services originating from hospitals, rather than a vendor in the longterm.