Digital Health Hope: Telemedicine and Increasing Access to Care
This is part four of RealClearHealth's five-part series: The Digital Health Hope. Each Friday, Dr. Kevin Campbell will explore the world of potential that digital health offers. Read the rest of the series by clicking the tag "Digital Health Hope" at the bottom of the article.
Telemedicine—which can be strictly defined as a remote virtual doctor-patient interaction—is rapidly gaining popularity. When initially developed, telemedicine was designed to allow health care professionals to evaluate, diagnose and treat patients in remote and rural locations using telecommunications technology. Now, many are beginning to utilize telemedicine as a replacement for the traditional doctor visit even when they are located in a city or town with many brick and mortar offices. The push for an increased use of telemedicine by insurers, third party payers, and many global businesses has led its development as a worldwide multi-billion dollar industry.
According to the American Telemedicine Association, there were 1.2 million virtual doctor visits in the United States in 2016 and almost 50 percent of physician groups now have telemedicine programs. Nearly 15 million Americans received some type of remote medical care last year and these numbers are expected to rise in the next several years. According to a survey from early 2017 by Advisory Board Company, almost 75 percent of respondents would consider a virtual office visit but thus far less than 20 percent of those in the survey had actually used telemedicine.
The Upside of Telemedicine
For years, many primary care physicians who practice in remote locations have relied on telemedicine to provide better care for their patients by gaining access to specialists at major academic medical centers. In addition, many common ailments—colds, flu, and other minor illnesses—can be easily and effectively treated via a virtual visit at a fraction of the cost to both patient and provider. A pending shortage of physicians in the US could potentially be addressed effectively by utilizing telemedicine and allow fewer physicians to see more patients virtually in a very efficient and cost effective environment. In addition, many older adults in urban and suburban areas often have difficulty traveling to their doctors' offices for frequent appointments and this can lead to non compliance and lack of adequate care.
Obviously, there will always be a need for face-to-face encounters but many medical issues can be dealt with easily on the virtual platform. Insurance companies and other payers have been pushing for the expansion of telemedicine as a way to curtail costs.
The Potential Impact on Rural Communities
One of the biggest areas that telemedicine can impact health care is in rural communities. Rural counties are significantly underserved by a lack of access to primary care service. Health care economics have resulted in the closure of more than 48 rural hospitals since 2010, according to the National Rural Health Association, and another 283 are in danger of closing in the coming year. In addition, roughly 1 in 5 people older than 65 live outside of a metropolitan area, and seniors usually have worse access to primary-care physicians and specialists if they live in rural areas. Telemedicine in these communities is likely to help those who have limited access to basic primary care services connect with health care professionals for disease prevention and treatment.
Telemedicine and Mental Health Treatment
With the growing shortage of mental health professionals and the increased incidence of mental illness and opioid addiction in the US today, telemedicine may provide a way to deliver high quality mental health care to a larger number of patients. According to Forbes, many companies are investing in the development of “telepsychiatry” programs. Currently 48 state Medicaid programs are reimbursing for mental health or behavioral telemedicine services. Telepsychiatry offers numerous benefits including improved access, increased patient privacy (since they can receive services in their home) as well as more frequent follow up in order to improve compliance with medications.
What Are the Challenges?
Many opponents of telemedicine cite questions about quality of care in virtual visits. As most patients will see a different provider every time they log on for a service, there is no established doctor patient relationship and many argue that this can complicate care. In addition, most States provide regulations for physicians and other medical practitioners and this means that there may be many different sets of rules and regulations that vary based on state. For now, physicians providing virtual visits must be licensed in the state in which they provide those visits, complicating accessibility of care. Only a limited number of states have agreed to allow physicians who are licensed in other states to quickly and easily obtain a reciprocal license.
While many physicians embrace technology as a way to improve patient care, there remains a significant skepticism among physicians when it comes to telemedicine. Many fear that much will be missed and misdiagnosis will be common in virtual visits. There is no possibility of physical exam during a telemedicine visit—one can only ask questions and observe what they see on the screen. Physicians also worry about how they may be reimbursed for a virtual visit as compared to a real life doctor patient encounter in this current era of declining salaries and increased health care costs. There is much debate among professional societies about what types of medical visits and for which types of medical problems are most appropriate for a virtual visit via telemedicine and guidelines are currently being created.
What is the Future?
I believe that the future of health care must incorporate telemedicine and virtual visits into any system going forward. It is likely that Medicare may be lead the way in the development of telemedicine programs for seniors. In order to address concerns over quality, we must have federal guidelines that are issued in response to recommendations by multiple professional medical societies in order to make it clear what types of cases are appropriate for a virtual office visit. In addition, there must be some consensus among the states as to how to license and regulate physicians who practice from a virtual office. We must also incorporate wearables, remote monitors and other data generating technologies into the virtual office visit in order to provide physicians with some objective data in addition to the patient interview that occurs during the telemedicine visit. Ultimately telemedicine is here to stay—how effective it becomes and how much it can benefit both doctors and patients is yet to be soon.