Telehealth and Medicine Today

Interstate Telehealth Policy and Provider Incentives: Recommendations to Combat Historically Low Physician Acceptance of Medicaid Patients

2020-05-31T17:08:58-07:00

Methods: A holistic, mixed-methods approach is used to investigate the research goal. Primary source telehealth reimbursement data obtained from the Medicaid offices of Florida and Nebraska, extensive literature review on Medicaid and telehealth policy, as well as secondary source data from online databases and previously published research were used to highlight the improvements needed to better implement telehealth programs across the country, as well as identifying precedential cases of policy changes regarding telemedicine.

Results: The primary and secondary source data analyzed in this article demonstrate the need for policy changes to address historically low physician acceptance of new patients through state Medicaid. Data obtained from Florida and Nebraska in Table 1 corroborate with the data in

Table 2 – both demonstrating how Florida reimburses at a much lower rate (0.79 to national Medicaid average) as compared to Nebraska (1.14 to national Medicaid average). Table 3 exhibits how national averages for Medicaid reimbursement, as well as Florida’s and Nebraska’s averages, fall below the national averages for Medicare reimbursement in all categories except obstetric care, showing that Medicaid services are reimbursed at a lower rate than Medicare in most circumstances.

Conclusions: Nationally, Medicaid reimbursement rates are among the lowest reimbursement rates of any insurer. Additionally, new Medicaid patients witness the lowest rates of acceptance by physicians, in large part due to low reimbursement rates. Medicaid policies and reimbursement rates vary across each state, making it difficult to enact any broad-sweeping policies to improve the access to care for Medicaid beneficiaries in the United States. However, by drawing reference to several policy changes involving Medicare, Medicaid, and telehealth, this paper presents recommendations for an incentivized cross-state telehealth policy aimed toward increasing Medicaid beneficiaries’ access to care. With nation-wide policy changes like those during the COVID-19 pandemic, there are historical examples and precedence to support policies focused on decreasing the limitations and barriers needed to practice telemedicine across state lines. This paper offers a potential, but limited framework for states to consider implementing in their Medicaid programs after conducting further research on the state-by-state level.

Avera eCARE: Medical Student Education in Telemedicine

2020-05-31T17:08:54-07:00

Purpose: The purpose of this research study is to explore medical student knowledge of and interest in telemedicine services in urban and rural communities. In the past, medical students have reported feeling unprepared to use telemedicine and uninformed about laws regarding telemedicine usage following graduation. However, they also reported that telemedicine training is relevant and important for their future work.

Methods: Study participants included medical students taking part in a two day telemedicine education program in 2018 and 2019. The first day includes a faculty seminar where students are introduced to telemedicine by experts in telemedicine innovations. The second day is a simulation day (SIM) where medical students complete a rotation at the Avera eCARE virtual hospital hub. A survey was given prior to the faculty seminar and re-administered following the SIM day. Questions asked about telemedicine knowledge, curriculum, and willingness to practice via telemedicine.

Results: A Chi-square analysis was used to look for associations’ pre/post by year. Both years show an increase in favorable responses for questions to telemedicine training and education. For analyses by topic area, we created clusters of questions to build scores. T-tests were used to look for associations’ pre/post by year. The analysis resulted in three topic areas to build scores. Both years show a significant increase in both Rating of Overall Knowledge and Interest in Curriculum and Utilization. There is no significant difference in Willingness to Practice.

Conclusions: Results show notable differences in how students perceive and understand telemedicine after structured exposure to telemedicine services. Further, this study demonstrates students' need for and interest in more telemedicine training opportunities in their curriculum. Results demonstrate no significant difference in the willingness to practice in rural settings. Future studies may focus on how telemedicine training is perceived by those more willing to work in rural communities.

Telemedicine step-wise consultation of a patient with multiple gunshot fractures of the long bones in recovery treatment system

2020-05-31T17:08:57-07:00

Due to the armed conflict in the East of Ukraine, it is relevant to investigate factors that affect patient outcomes with the use of telemedicine. This applies especially to patients with multiple gunshot fractures, which is the most severe category at increased risk for complications and unsatisfactory results. A case study is reported here.

Predictive Modeling for Telemedicine Service Demand

2020-05-31T17:08:56-07:00

Introduction: Emergency teleneurology care has grown in magnitude, impact, and validation. Stroke is a leading cause of death in the US and the timely treatment of stroke results in better outcomes for patients. Teleneurology provides evidence-based care to patients even when a board-certified neurologist is not physically on site. Determining staffing demand for telemedicine consultation for a specific period of time is an integral part of the decision-making activities of providers of acute care telemedicine services. This study aims to build a forecasting model to predict consultation demand to optimize telemedicine provider staffing. Such forecasting models acquire added importance in emergency situations such as the current COVID-19 pandemic.

Materials and Methods: This study trained consultation data of SOC Telemed, a private telemedicine provider, from 411 hospitals nationwide and involving 97,593 incidents of consultations. The forecasting model analyzes characteristics including hospital size (number of beds), annual volume, patient demographics, time of consultation, and reason for consultation.

Results: Several regression techniques were used to demonstrate a strong correlation between these features and weekly demand with r²= 0.7821. Reason for consult in the past week was the strongest predictor for the demand in the next week with r²= 0.7899.

Conclusion: A predictive model for demand forecasting can optimize telemedicine resources to improve patient care and help telemedicine providers decide how many physicians to staff. The goal of the forecasting model is to improve patient care and outcomes by providing physicians timely and efficiently to meet consultation demand. The ability to predict demand and calculate expected volume allow telemedicine providers to schedule physicians in advance. This mitigates the clinical risk of excess patient demand.and long waiting time, as well as the financial risk of surplus of physicians.

Space Medicine: The Ultimate in Remote Healthcare

2020-05-31T17:08:55-07:00

The term “Remote Health Care” (RHC) more clearly defines what is implied by Telehealth or Telemedicine. The latter terms clearly indicate delivering health care at a distance using Information and Communication Technology. Distance today has become meaningless–at least on earth ! Geography has indeed become History. The ultimate in providing RHC would be to continuously monitor in almost real time, various health parameters of those in outer space, staying in Low Earth Orbit at present. Eventually this would extend to the lunar surface, deep space and one day perhaps even on the red planet Mars. This overview discusses some of these challenges.

Role of telemedicine in healthcare during COVID-19 pandemic in developing countries

2020-05-31T17:08:56-07:00

Abstract: COVID-19 is a public health emergency of international concern. Ensuring primary healthcare during this pandemic appeared to be a great challenge. Primary healthcare services are being disrupted due to lockdown, lack of protective gears and hospital facilities, risk of infection spread to non-COVID patients and health professionals. People with acute and chronic ailments including diabetes, pregnancy, obesity, chronic respiratory diseases, cardiovascular disease, cancer, mental health conditions are in trouble. In this article, the challenges in primary healthcare in developing countries during COVID-19 pandemic have been analyzed and the role of telemedicine in addressing these challenges has been discussed. Telemedicine can play an important role in this pandemic by minimizing virus spread, utilizing the time of healthcare professionals effectively and in alleviating mental health issues.

Why Veterinary TeleHealth is Critical to Keeping Our Pets (And Ourselves) Healthy During - And After - the COVID-19 Crisis

2020-05-18T17:16:08-07:00

I have been very lucky to work almost exclusively in the field of veterinary telemedicine for over a year. I see patients over video and phone consults for a myriad of issues that can be managed at home. Planning, implementing, and troubleshooting a well-rounded telemedicine program in our large 30-veterinarian hospital has been exciting, new, and intimidating for everyone involved. A year ago we had no idea how extensively the program would be put to the test with the public health crisis that is COVID-19. Telehealth has a whole new purpose in this new reality. We have realized that while trying to ride the wave of current events, many of our colleagues are just dusting off their surfboards - or even more concerning, are still sitting on the beach.

I believe strongly that telehealth is an essential organ in the veterinary beast - and it has been for years. Telehealth has always been a part of any veterinary business, and it happens every day in every practice around the world. Like any untrained muscle, it can be challenging and uncomfortable to intentionally strengthen it - but it has always been there. When I speak to my colleagues about telehealth, the first thing I remind them of is that they are already doing it. Granted, a big portion of this is done by paraprofessional staff: mainly client service representatives, veterinary nurses, and assistants. Teletriage and teleadvice is being regularly performed over the phone, either when the client first contacts the clinic, or as veterinary nurse consults. Continuing care is also done daily on the phone, through email, or with voicemail tag. All of these communications, when done well, take hours of employee time and require years of professional and on-the-job training. Although the medium of multiple phone calls and voicemails feels familiar and therefore comforting, they are inefficient to document, confusing for a third party to interpret, and difficult to monetize.

With the continuing effects of COVID-19 stretching out with unknown horizons into the future, likely resulting in a society that is forever changed, it is naive and perhaps negligent to assume life will return to “normal” and telemedicine will become a dying fad. COVID-19 has underlined the importance of telemedicine to the general populace by helping clients and providers socially distance and reduce unnecessary travel. However, this has always been and will continue to be a concern for many of our clients even without a worldwide health crisis. COVID-19 has opened all of our eyes to the dangers and anxieties of navigating the world as someone who is immunocompromised. However, those concerns will continue to exist for our community members who are battling illness, differently abled, do not have access to transportation, or are away from home. Human medicine has trailblazed this space already, and offering virtual doctor’s visits has become more and more accepted with readily observed advantages in convenience and patient access. Deeming telemedicine as unnecessary or too risky for practitioners is the coward’s way out of developing better care for the marginalized.

In addition to providing better care for clients, I have seen patients benefit greatly from well-utilized telemedicine. I am the first to agree that the physical exam is the cornerstone of good veterinary medicine, and telehealth must be used shrewdly and with careful judgement (just like every other tool in the veterinary arsenal). However, there are many common consults that fit beautifully into the virtual space. Very anxious pets can experience stress-free vet consults in their comfort zone, with no danger of canine scuffles in the lobby or losing an escape artist cat in the parking lot. Exposure to infectious illness in the hospital can be reduced. Without the adrenaline of the hospital and white coat syndrome, I can often get a more accurate picture of what the client is seeing at home. Behavioral issues, good husbandry techniques, new puppy education, mild/moderate skin issues, acute lameness, diarrhea, and many other common issues can be discussed at length and often successfully treated. To be abundantly clear - telemedicine is not the space for the lethargic or very painful pet, the intractably vomiting pet, or the nonambulatory pet, just as these cases are not to be handled solely over the phone. There are still issues that must be seen in the hospital. There is no escaping using good judgement, and there is never a one size fits all for every situation. Luckily, this is nothing new to the experienced veterinary practitioner.

I too am clinging to the hope that soon things will be “back to normal.” However, COVID-19 has opened our collective eyes to the many advantages of conducting telemedicine in a purposeful and intentional way - in which an effective medium is used, efficient and thorough documentation is maintained, and the client is charged at a fair rate for a practitioner’s undivided time and attention. Clients will expect us to continue to provide this service even when social distancing becomes less critical for the average community member. Many veterinary practices have realized that a well-established telehealth program increases efficiency, revenue, and client satisfaction. Necessity being the mother of invention, this era of unprecedented challenges is also the birthplace of triumphant problem-solving. A sure way to add to this pandemic’s staggering losses to humanity would be to emerge on the other side refusing to embrace new technologies and ideas in order to grow, both as a profession and as a community. That said, this is neither the first nor the last challenge we will face together as a field, and small-minded fear is not a new enemy. I have abundant faith that we will not allow it to guide us going forward, and instead choose to explore exciting new ways to relieve animal suffering and protect global health.