The Growing Acceptance of Telemedicine
Telemedicine use has grown phenomenally as patients become more accepting of remote evaluation, diagnosis, and treatment.
“The use of telehealth is going to grow,” said Mei Wa Kwong, JD, executive director of The Center for Connected Health Policy in Sacramento, California. “There is a shortage of healthcare professionals, and they are not distributed in all the places people need their services.”
Healthcare attorney Jayme Matchinski, at the firm Greensfelder in Chicago, added, “Telemedicine is gaining traction because it is easy for patients and physicians.”
Stuart Pologe, COO of Night Nurse, which provides telephonic triage services in 37 states, suggested that remote care is becoming more accepted by patients and others, due in part to the shortage of providers in some locations.
“Access to care needs to be more universally available, whether in the city or rural [setting],” Pologe said.
Consultant Thomas Davis, MD, FAAFP, in St. Louis, added that telemedicine can increase a physician’s productivity.
“I can treat more than twice as many acute patients per hour in a telemedicine practice as I can in the office,” Davis said.
Jon Pearce, CEO of Zipnosis, a virtual care provider based in Minneapolis, added that “to make virtual care a reality and meet patient expectations, we need to focus on personalizing the patient experience, leveraging innovative technologies to tailor care to individuals’ unique needs.”
A recent Harvard public health study in a Journal of the American Medical Association research letter found that among members of one health plan, annual telemedicine visits increased from 0.02 per 1,000 members in 2005 to 6.57 per 1,000 in 2017. More than 83 percent lived in urban areas.
“It’s not just for rural areas,” Matchinski agreed. “Telemedicine is used in large metro areas.”
Thirty-two states, as of 2016, have passed parity laws, requiring coverage and reimbursement for telemedicine. The Harvard study found that mental health tele-visits increased in areas with no psychiatrists and comprehensive parity mandates. However, parity laws did not increase primary care telemedicine visits.
Kwong added that telepsychiatry is the most reimbursed specialty by public programs, including Medicaid.
Mordor Intelligence, a research firm, released an analysis of the global telemedicine market share and forecasted compound annual growth of 18.83 percent from 2018 to 2023. It valued the 2017 telemedicine market at $32,842 million. Drivers include Medicare reimbursement for telehealth claims.
The Centers for Medicare & Medicaid Services has expended reimbursement in the fiscal year 2019 for Internet communication technologies, including virtual check-ins and remote evaluation services.
Vidyo, an embedded video technology company in Hackensack, New Jersey, recently released a study that found more than 75 percent of 300 health care delivery organization respondents reported operating or planning to launch telehealth services. Two-thirds of the respondents plan to spend 20 percent or more of their technology budget on telemedicine.
Elana Anderson, chief marketing officer at Vidyo, said in a release that she expects “2018 will be the year that ‘telemedicine’ becomes standard medicine and mobile or remote access becomes the new normal.”
Anderson attributed much of that to patient satisfaction with telemedicine, its efficiency, return on investment, and timeliness of care.
Telemedicine addressing specific needs
Kwong reported on the federal and state levels a public health telemedicine trend toward addressing the opioid epidemic because of the limited number of professionals trained to treat substance abuse disorder. “A lot of policy has focused on counseling and mental and behavioral health,” she said.
The Opioid Crisis Act includes directing agencies to create rules related to prescribing opioids through telemedicine.
Emergency departments in community hospitals often rely on tele-stroke with a neurologist at a major medical center, and telemedicine services have been used to help remote victims of natural and man-made disasters.
Numerous professionals, including dentists and anesthesiologists, can practice telehealth.
“Dentists usually have a dental hygienist with the patient, working the exam camera,” said Kwong, explaining that patients may see the hygienist for a cleaning and the dentist performs the check-up remotely.
While Kwong reported that most of the telemedicine physicians she works with practice telemedicine part-time, some full-time telemedicine jobs exist with large telemedicine providers, such as American Well and Teledoc. Some locum tenens jobs with firms like Staff Care can include a full-time or part-time telemedicine element.
Opportunities in telemedicine also exist for nurse practitioners, physician assistants, allied professionals, and registered nurses, with various models for supervision and oversight.
As some of the barriers to telemedicine come down and patients increasingly expect remote care, the technology will likely grow in popularity, supporting more jobs. “This change is coming,” Kwong said.
Search telemedicine jobs at Staff Care.
Telemedicine challenges to providers
While telemedicine trends suggest increased telemedicine use, physicians need to exercise caution before jumping in, Matchinski recommended.
Providers must be licensed in the state where the patient is located. The Interstate Medical Licensure Compact for physicians and the Enhanced Nurse Licensure Compact for advanced practice nurses and RNs are helpful in securing that licensure in member states.
Additionally, Matchinski recommended physicians review the medical practice act in the states they plan to provide remote care, to understand the scope of practice, to set up protocols for handling calls, to record calls and save them in the medical record, and to discuss their expansion into telemedicine with their professional liability carrier.
“Liability is an issue if there is a missed diagnosis or communication,” Matchinski said. “Physicians need to be careful with it.”
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