Telemedicine in the Modern Healthcare Industry
Telemedicine is a more recent development in the healthcare world. Rural communities and people in similar situations can now have access to medical care that can help them make the decision of what to do next with their ailment. The Ambulatory M&A Advisor takes a look at some of the developments coming for telemedicine in the near future an the impact that it has had on the communities it serves.
David Boucher, President, COO of UCI Medical Affiliates says that healthcare can be very local so the success of it all depends on why an urgent care is interested in getting into telehealth and what they are hoping to get out of it.
“We began offering telehealth services back in July of 2014 in a load balancing format. This is where a patient might come into a center that is particularly busy, and they have an option where they might be able to see a physician in about an hour, or they could see a physician right now. The patient goes into an exam room with a nurse where we have technology and tools available…… and the physicians treating these patients actually work out of their homes or in a different office.
I think that there are a number of reasons why providers would want to get into telehealth and there are a ton of questions to ask:: Is the facility getting into it to grow their visits? Is it to expand their geographic footprint?” Boucher says.
“Doctor’s Care is a 35 year old company and was one of the first urgent care companies in the United States. We have a longstanding footprint, so for us, it was an opportunity to offer our services to a number of rural areas around the state. Historically, these areas had hospitals, but they have closed down in the last 10 or 15 years, which is increasingly common across the United States.”
For Boucher and Doctor’s Care, the major driving factor was to improve patient satisfaction.
“We struggle with wait times, just like about every other urgent care in the country. We had to try to mitigate that whole compression/expansion theory of physics. If we can eliminate 10-25 patients a day from the queue by having them be seen via telemed, then we wanted to try to do that.
It may also be away to improve coverage as a patient centered medical home. Some urgent cares are starting to jump into the whole PCMH area – a place where telehealth can facilitate the clinical care continuum. Telehealth might also be another way to strengthen brand loyalty. With today’s technology, it is relatively easy and not cost prohibitive for urgent care to get into telehealth,” he says.
Roger Downey, Communications Manager with GlobalMed says that there is a great deal of interest in consumer telehealth firms.
“These are the services you might call in the middle of the night or on weekends to speak to a physician. Everybody is talking about how the industry is moving to have these programs as part of their employee health plans. While they can be effective for minor problems, they are only a band-aid for more serious issues. The consumers have never met the doctors before, and the doctors are trying to assess them based primarily on their description of symptoms. There is no “evidence” a physician can base his diagnosis on. When there is a need for evidence from a clinical exam, they have to be referred to a local doctor, to a specialist, or go to an emergency room,” Downey says.
Downey says that more advanced systems allow a physician to do a clinical examination of a patient remotely, with the same kind of medical devices that they would use in their offices.
According to Downey, in these situations, patients are being helped by a patient presenter, like a nurse or physician’s assistant. These individuals act as the doctor’s hands and follow directions on how and what to do during the patient exam. The doctor sees the data live in real time and comes to a conclusive idea as to what to do next with the patient to improve their health via a prescription or some sort of treatment plan.
“This type of telemedicine is mostly being done in rural areas, simply because Medicare at the current time only reimburses for patients seen in rural or medically underserved areas. It doesn’t reimburse for patient visits in urban areas; at least not yet,” Downey says.
“There is a telemedicine waiver with the new Next Gen ACOs which allows them to take on more risk but also to do telemedicine with patients anywhere, even in their homes. That is a new kind of program that is only now beginning to get started. It is the next step in terms of utilizing telemedicine before there is congressional action to change the way Medicare reimburses.”
Downey adds that the congressional budget office has really been a roadblock in this because it doesn’t see that telemedicine is a substitute for in-person visits. It maintains that virtual visits represent additional money spent on medical care.
“Whereas we see it as a substitute, it is more than that when you consider a more timely medical intervention can help prevent a patient’s condition from getting worse.
This is really true with access to specialties where sometimes it takes weeks or months to see a specialist. With telemedicine, if nothing else, the specialist can spend five or ten minutes and at least triage the patient. The visit would be an important step to discovering the nature of the problem and seeing what needs to be done,” Downey says.
Boucher says that when considering moving into the telemedicine direction, one of the things that he tries to advise is that before any center gets involved with telehealth, they should have some serious conversations. They need to review their payor contracts, they need to talk to their payor reps and be up front with what they are doing and why.
For load balancing, Boucher says there is not a lower cost, so physicians still have the patient physically walking into a brick and mortar center.
“The nice thing about that is if that particular patient needs an X ray or lab services, we are all set up and the patient may conveniently access these,” Boucher says.
Generally payors will instruct providers to use a modifier, build the E&M reimbursement for a particular service to show what they plan to reimburse. As most of know from reading in-flight magazines, “You don’t get what you deserve, you get what you negotiate”, Boucher says, adding that every center is going to have to deal with their reimbursement levels.
“With direct-to-consumer, different payors have gotten involved with different entities. Oftentimes, they will want the provider to play in their playground. We can’t have one or two providers functioning on five to six different IP platforms. It would get schizophrenic…very quickly,” he says.
The Future of Telehealth
Boucher says that the modern healthcare system represents such a pioneering time. This is a time where physicians don’t want to limit where they are going with telemedicine, and want to engender an innovative environment.
“I think there is a huge up side within the next 4 to 5 years. There are obvious opportunities for prisons, schools, colleges to utilize telehealth. We live in a time where convenience is key, and fast food is just not fast enough. Whether 65 or 16 years old, it is all about the convenience or getting the care that you need,” Boucher says.
“Looking back 5 years ago, employee on-site clinics came into vogue. We think as telehealth continues to mature, smaller employers that might not be able to cover having a full-time doc in an office; it significantly lowers the price point by having the telehealth cart available.”
Karen Thomas, President of Advanced Telehealth Solutions says that as far as the future, she continues to be optimistic about telemedicine, especially due to the changes in reimbursement for both hospitals, physicians and home health agencies.
“More and more CRGs at hospitals are being included in bundled payment to test them. Reimbursement will continue to drive it,” Thomas says.
“I think as with anything new or up and coming, programs can continually be refined and develop in such a manner that they improve their outcomes, are more precise, and work well with those physicians and patients.”
If you would like to learn more about the concepts covered in this article, want to sell your business or discuss how Ambulatory Alliances, LLC might be able to help you out, contact Blayne Rush, (469)-385-7792, or Blayne@ambulatoryalliances.com.