Archive for October, 2014


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A tourist couple take a photo in an iconic red telephone box in Parliament Square as snow falls in London, Friday, Jan. 18, 2013. (AP Photo/Alastair Grant)

Tim Bright’s work as a well‐site geologist for Denver‐based Columbine Logging Inc. takes him from his home in Las Vegas to jobs all over the Rocky Mountain region. One Saturday in early November, Bright was preparing to go to an undeveloped job site in northern Nevada, where he would spend three weeks away from civilization.

Then he realized he didn’t feel well.

“My throat was sore and my lymph nodes hurt,” he says. “As time went on, I felt worse.”

Going to his doctor would have meant not working on Monday—if he could get a Monday appointment—and when Bright isn’t working, he doesn’t get paid.

Going to the doctor from his job site wasn’t a great choice, either.

“We live and work at the well site, working for a couple of weeks at a time, then taking a week off,” Bright says. “You’d either have to go to the doctor when it’s not your 12‐hour shift, or call the boss to send in someone else to come take your shift. The boss is in Denver. I’m in the wilds of Nevada. Calling to get relief for just one day would not go over too well.”

So Bright used his employer’s new telemedicine benefit.

“I had a conversation with a nurse first, then a doctor called me back and wrote me a prescription for an antibiotic,” Bright says. “At first I was a little hesitant, because you kind of feel like you want the doctor to see you. But basing a treatment on my description is pretty much what they do anyway at a doctor’s appointment. The antibiotic worked, and I think this is a neat idea and a really useful tool for people like me who work way out there.”

It’s a useful tool for Bright’s employer, too. Kurt Sonka, who is Columbine’s vice president of accounting, says that in September, the firm began paying $6 a month per employee for a telemedicine benefit from Chicago-based First Stop Health. Columbine offers the benefit in addition to a standard health package.

“A lot of our employees work remotely on oil rigs, so they might have to drive 100 miles to see a doctor,” Sonka says.

Talking to a physician by telephone lets workers get health care without leaving the job site, which would typically involve a day without pay. It also means the company doesn’t have to put a project on hold while it finds and transports a substitute worker.

It’s not a cure‐all

To be sure, there’s a lot things telemedicine can’t do, from prescribing opiates to setting a broken bone or biopsying a suspicious lump. But for antibiotics, lower‐strength pain medications, antihistamines, basic dermatology, forgotten medication, and questions about whether an in‐person doctor’s appointment is warranted, a doctor who is available by voice, Face Time, or Skype can be just the ticket, says Deb Loughlin, a principal at Digital Benefit Advisors in Colchester, Vt.

“They can triage stuff like hernias, which can be boring or an emergency,” Loughlin says, or suggest an over‐the‐counter medication that would help someone who can’t easily reach a pharmacy or is traveling outside the United States, where American physicians can’t prescribe.

Some people insist on seeing their own physicians, who have their complete medical records. Many more, however, are accustomed to having their needs met immediately through remote technology, particularly when they are nowhere near their regular physicians.

“People travel a lot more than they used to, and the things they need are often urgent, but not emergencies,” Loughlin says.

Other potential telemedicine clients include anyone who’s away from home, whether traveling, working, or going to school;college‐age adults who have graduated from a pediatrician’s care but don’t yet have an adult primary care doctor;people who work in the wilderness;individuals who are used to technology driving simple, immediate solutions;and anyone who can’t easily take time away from work to visit a doctor.

A lot of people share an enthusiasm for telemedicine, it seems. According to a report from the Wellesley, Mass.‐based market research firm BCC Research, the telemedicine market was worth an estimated $11.6 billion in 2011, up from $9.8 billion in 2009. Over the next five years, the market’s compound annual growth will reach an estimated 18.6 percent, with the telehospital and teleclinic segments estimated to grow at 16.8 percent during that time period.

Growth spurt

First Stop Health is riding that growth. The Chicago-based company started in 2011 and launched its product in the autumn of 2012.

“Our goal is to make the cost of health care lower, especially as the cost of health care rises and high-deductible plans proliferate,” says company cofounder and CEO Patrick Spain. “This can help bring down costs, particularly with self-insured employers. Telemedicine doesn’t cost very much, but it’s an important potential way to save. The challenge is to take something that looks minor and sell it as a potentially major way to save. We want brokers to make it part of nearly every package they pitch.”


The time is right for telemedicine, Loughlin agrees, “It’s definitely on the rise, driven primarily by economics, but also by culture. It’s more and more supported within regulation, and insurers are being told that they need to support it.”

A variety of bills around the country, both pending and final, will allow doctors to practice telemedicine across state lines and requiring carriers reimburse telemedicine services.

Cost controller

On the economic side, Loughlin says, is telemedicine’s ability to tamp down the rising cost of health care by allowing consumers to use less face time with doctors. A company that offers workers telemedicine in addition to a standard medical plan, she estimates, might save 25 percent on medical costs. If the company is self-insured, that savings goes directly to the bottom line. If the company is fully covered, that savings likely translates to lower premiums.

Telemedicine saves money, experts say, because physicians charge less for a telephone call than from an in-person visit. About 50 percent of office visits are unnecessary, Spain says.

“The typical family of four goes to a doctor 14 times a year. Eight of those visits could have been handled over the phone. If someone uses telemedicine, even imperfectly, they might avoid four of those visits, at about $100 a piece,” Spain says.

When his company road tested its product, “90 percent of the people who called got a reduction in the overall cost of their care, because they downgraded from emergency room to urgent care or didn’t need a visit at all,” he adds. “Only 10 percent of the calls were people that the teledocs couldn’t really help.”

Telemedicine also can increase worker productivity, because an employee doesn’t need to take half a day or more in sick time in order to deal with a medical issue. Because telemedicine offers immediate access to medical professionals, workers aren’t chained to their desks all afternoon, afraid to attend a meeting because they’re waiting for a doctor to return their telephone calls.

“Doctors aren’t typically paid for telephone calls, and people work around getting a call back from them,” Loughlin says.

A lack of pay makes returning patient calls a low priority for many doctors. Others are simply overwhelmed by patient needs. A typical primary care doctor in Vermont might earn $125,000 a year, Loughlin estimates. In the medical world, that’s not a huge salary, so relatively few medical students choose primary care as a career.

According to a Nov. 7, 2013, article in the Wall Street Journal, only about 20 percent of medical students choose primary care specialties—pediatrics, internal medicine, and family medicine—as their focus.

That leaves too few primary care doctors taking care of too many people already, and the problem is only getting worse. Millions of formerly uninsured patients will buy insurance through the Affordable Care Act’s exchanges, and ten thousand people will turn 65 every day for the next two decades. By 2020, the Association of American Medical Colleges predicts, the United States will be short 45,000 primary care doctors.

Those doctors would have acted as medical advocates, in addition to directly treating patients. Spain says telemedicine can help replace those services, too.

“If someone has a serious crisis and needs help getting information about treatment options, a telecom can give advice about whether that person needs a local provider or a center of excellence. Sometimes the wait can be a while at a center of excellence, and a medical advocate can sometimes cut down on the wait,” Spain says.

More than meds

Administrative advocacy is another potential telemedicine service.

“A surprising number of medical bills are wrong, and not in your favor,” Spain says. “One of our members was in a car accident and broke her leg. The emergency medical technicians called a helicopter to take her to the hospital, and then she got a $42,000 bill for the helicopter ride. An ambulance would have been both faster and cheaper. So she called the telemedicine service. They did an analysis around whether the helicopter ride was medically necessary, and they got the bill down to less than a tenth of the original amount.”

To realize all these benefits, employers, brokers, and providers need to persuade workers to use telemedicine as a first responder. That may not be easy.

“When we started rolling this out to employers and agents, nine of 10 customers had never heard of telehealth. The brokers were familiar with it, but sometimes not in a positive context, as telemedicine used to be sold as a low-cost benefit that hardly anyone used,” Spain says. “In one case, we talked to an employer who had telehealth for about 300 employees for three years. In those three years, no one had called.”

So First Stop Health uses a different approach. The company sends emails, offers webinars, and issues reminders such as stickers and magnets to dispersed workforces.

“We want our customers’ employees to use this,” Spain says, adding that his company aims for 20 percent participation — “not the usual 1 percent to 2 percent. If we get 15 percent to 20 percent of employees to use the service at self-funded employers, the investment will be repaid three to four times.”

It’s still early, Spain emphasizes, but so far about 70 percent of contacted brokers seem interested in selling the benefit. Time will tell how quickly it catches on.


Posted by mdglobal

The crisis that every consumer or business owner faces when buying health insurance is caused by a flawed system. Most carriers rely on agents and brokers to sell their products and give them incentives — commissions – to do so. What happens when premiums go down? Commissions go down. Therefore, agents and brokers really have no incentive to offer product solutions that will bring premiums down. Health care consumers are being fleeced by undereducated health care brokers who are over-occupied with commissions.

Read More


Posted by mdglobal

Employers switching to telehealth technology over face-to-face visits rein in costs

Looking to save a few bucks? Telehealth might just be the golden ticket to getting there, at least according to new analysis suggesting the remote care delivery model could potentially save U.S. companies a whopping $6 billion.

The research, conducted by folks at the global professional services company Towers Watson, underscores that this level of savings, of course, can only be realized if all U.S. companies’ employees and their dependents ditch face-to-face physician and urgent care visits, swapping them for telemedicine interactions when available. Realistically, that’s a lofty goal for even the most tech-savvy companies, but analysts say even a much lower level of telehealth adoption could signify hundreds of millions of dollars in savings, still.

[See also: FCC gives telehealth $400M boost.]

“Achieving this savings requires a shift in patient and physician mindsets, health plan willingness to integrate and reimburse such services and regulatory support in all states,” Allan Khoury, MD, senior consultant at Towers Watson, said in a statement.

This shift is occurring, but at what rate? After surveying some 420 midsize to large U.S. companies, 37 percent of employers said by next year they anticipate offering employees telehealth services as a low-cost alternative to face-to-face visits for nonemergency health issues. Some 34 percent indicate it will be longer before they get onboard with telehealth, citing a two- or three-year time frame.

[See also: Texas hospital takes off with telehealth and FCC gives telehealth $400M boost.]

Of employers surveyed, 22 percent currently offer telehealth alternatives, officials noted. But just because employers offer telehealth services doesn’t mean employees are actually using the technology, Khoury added. On the contrary, only 10 percent of members who have the services available actually utilize the services.

“With both insurance companies and employers encouraging its use, telemedicine is going to have a growing role in the spectrum of healthcare service delivery,” said Khoury. “We’re also likely to see that it’s just the tip of the iceberg.”

This tip of the iceberg for the telehealth market has seen a 237 percent growth within a five-year period, according to a recent Kalorama industry report. Already, the telemedicine patient monitoring market grew from $4.2 billion in 2007 to more than $10 billion in 2012.


Posted by mdglobal

Can long-distance virtual doctors stop U.S. healthcare costs from spiraling out of control? Better still, can these camera-ready physicians deliver an even better quality of care?

Lawmakers in Washington think so, and they are pushing to expand the use of telemedicine and other technologies that will cut costs, ease doctor shortages and improve healthcare outcomes.

Telemedicine–the technology allowing doctors to visit patients via a Skype-like program—is already being used widely across the country.

Related: The Doctor is in your TV: a $27 Billion Business

Several insurance companies including WellPoint have established specific services for patients that utilize these tools instead of going into a clinic. For instance, if consumers want to schedule an appointment for a cold or the flu, doctors can simply beam in via a computer screen, assess the patient and write a prescription, all from potentially hundreds of miles away.

According to a study by the Affiliated Workers Association, more than 36 million Americans have already used telemedicine in some way, and as many as 70 percent of doctor visits can be handled over the phone—which typically cost much less than an in-person visit.

Though telemedicine has become more mainstream, insurance companies do not always reimburse doctors for these services. Several states, including Florida, have legislation pending that would create statewide insurance standards for telemedicine. Additionally, several pieces of legislation in Washington would require federal health programs to cover the new cost-saving technology, which is currently very restricted –especially under Medicare.

Under current law, Medicare can only reimburse telehealth for patients located outside city limits or in areas with a provider shortage. One measure, sponsored by Reps. Gregg Harper would expand that to large metropolitan areas as well.

Proponents of the technology say it is a proven cost-savings practice.

Related: Got Coverage? Great. Now Try to Find a Doctor

In one study by the Center for Information Technology Leadership, the researchers examined the impact of implementing telemedicine practices in emergency rooms and found that the cost to equip all US emergency departments with telehealth technologies could easily be covered by reductions in transfers between patients.

“From a baseline of 2.2 million patients transported each year between emergency departments at a cost of $1.39 billion in transportation costs, hybrid technologies would avoid 850,000 transports with a cost savings of $537 million a year,” the study said.

In another study, researchers at Health Affairs measured the spending difference between chronically ill Medicare patients that used a telehealth program and those that did not. They found that patients that had used the telehealth program had spending reductions of 7 to 13 percent or $312–$542 per person per quarter compared to those that did not.

“These results suggest that carefully designed and implemented care management and telehealth programs can help reduce health care spending and that such programs merit continued attention by Medicare,” the researchers said.

Related: Opening the Black Box of U.S. Health Care Prices

Lawmakers say federal health programs could experience similar cost savings by requiring these programs to accept the new technological alternatives to in-person care.

“Technological advances have created new opportunities for enormous advances in health care delivery. However, this progress is stymied by an outdated statutory regime that restricts the use of telemedicine under Medicare,” the bill’s sponsors wrote in an Op-ed published Roll Call. They added that states that already required Medicaid to cover telehealth consultations have created a “pathway to expand telemedicine on the national level.”

This isn’t the first time federal lawmakers have tried to expand the use of telemedicine. Rep. Mike Thompson (D-CA) sponsored the Telehealth Promotion Act of 2012, which would have increased federal support and payments for telehealth services nationwide. According to the bill’s sponsor, the legislation would extend those benefits to nearly 75 million Americans. The measure failed to get out of committee.


Posted by mdglobal

This article appears in the October issue of HealthLeaders magazine.

Healthcare systems find that telemedicine can help grow their volume and drive out inefficiencies, but new methods of care delivery require thoughtful planning to avoid hiccups.

The UC Davis Health System now offers access to 30 specialty care services ranging from behavioral health and dermatology to audiology and ophthalmology for both children and adults.

Recently, the system reported it was able to grow its pediatric medicine practice through telemedicine. In a study published in the July 2013 issue of Telemedicine and e-Health, authors from the UC Davis Health System reported 2,029 children transferred to the hospital from 16 surrounding hospitals connected via telemedicine between July 2003 and December 2010.

From these patients, average hospital revenue increased from $2.4 million to $4.0 million per year, and average professional billing revenue increased from $314,000 to $688,000 per year.

The Sacramento, Calif–based system, which has 619 licensed beds and reported total operating revenue of $1.3 billion in 2012, has the benefit of being in a state that has long recognized the practice of telemedicine.

“Our experience has been positive with private payers in California,” says Shelley A. Palumbo, chief administrative officer for UC Davis Health System’s Center for Health and Technology and the Center for Virtual Care. “In fact, several payer organizations have attended the UC Davis Telehealth Education Program to better inform themselves about telehealth and the benefits for their membership.”

Since starting its telemedicine program in the early 1990s, UC Davis Health System has provided nearly 37,000 consultations that way. This represents synchronous (real-time communication) and asynchronous (recorded and stored for another time) telehealth consultations to more than 100 sites spanning 44 of California’s 58 counties, Palumbo says.

“Patients and their physicians can connect with UC Davis doctors from many different locations, including rural hospital emergency rooms, community clinics, and Native American healthcare sites” she says.

Integrated delivery networks have been able to sidestep reimbursement issues due to the fact that they own their own insurance companies.

In Utah, Salt lake City–based Intermountain Healthcare enrolled about 77,000 Medicaid participants under full capitation in January, says Wesley Valdes, DO, telehealth services medical director at the 22-hospital system.

“Once you’re capitated, you’re freed up from thinking like fee-for-service, and now you can look at what we jokingly say is how we really want to take care of patients without having to worry about justifying everything as a single encounter,” Valdes says.


Posted by mdglobal

The future of healthcare is happening now in Oregon.

When a seven-month-old baby had a fever over 102 and a rash, doctors at a small hospital in rural Oregon used telemedicine to connect to Oregon Heath and Science University. She was eventually diagnosed with a serious bacterial infection. The decision? To fly the child to the Portland, Oregon hospital.

From the story at the Portland Business Journal:

That decision was critical…
The child, who is now 3, spent 111 days in Portland and had her legs amputated above the knee. She’s now doing better and has no memory of the trauma.

This week, the Portland Business Journal will be running a series of stories about how telemedicine is working in Oregon to enhance medical care, particularly in rural areas. Be sure to check it out.

According to PBJ, the ”OHSU Telemedicine Network includes 14 hospitals and offers pediatric and neonatal intensive care, stroke, trauma and other services.”

Follow MedCity News on Facebook and Twitter for more updates.

CORRECTION: In the original version of this article, it said the patient was diagnosed with a virus.


Posted by mdglobal

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