Telemedicine: Answering the Call of Those Who Need It Most
Many veterans aren't receiving the health care they desperately need. Among them was Iraq War veteran Curtis Gearhart, who committed suicide last year. Gearhart, who had suffered from PTSD and recurring headaches from a tumor, sought out care but was told by the Veterans Affairs (VA) office that it would be five to six weeks before they could see him for medical care.
Gearhart’s story is heartbreakingly common. In 2015, the VA’s Health Administration estimated that over 307,000 veterans had died while waiting for medical care. With 10 percent of veterans sustaining serious injuries and 24 percent left disabled from combat, quick access to medical care is critical.
So what can be done to ensure that veterans with urgent medical needs have such access?
An increasingly common answer is telemedicine. Telemedicine – using telecommunication technology to help administer medical care – provides patients swift and reliable contact with a physician at a distance. Currently, 71 percent of health care providers use telemedicine tools. Telemedicine can provide swift service when care is urgent and time is short, and, perhaps, save the lives of patients like Gearhart.
The VA already uses telemedicine on a large scale, accounting for approximately two million clinical encounters at a cost of $1.2 billion in 2016. But it isn't yet available to all its patients.
Recently, the VA announced plans to increase telemedicine access by enacting an “anywhere-to-anywhere” program that would allow VA physicians to override state-licensing restrictions to provide care beyond state boundaries.
According to VA Secretary David Shulkin, “We're going to be issuing a regulation that allows our VA providers to provide telehealth services from anywhere in the country to veterans anywhere in the country, whether it's in their homes or any location.”
However, several groups oppose this plan, fearing it would undermine the states’ power to regulate medical practice. Others say that access to telemedicine should be restricted until its quality improves.
These concerns, although well-intended, are largely misguided. Telemedicine provides high-quality medical care even in challenging situations.
Physicians in Delaware successfully provide care using the telemedicine program MEND, which the Medical Society of Delaware had approved after declining to use several other products, fearing a lack of “continuity of care.” As of October, physicians were able to “visit” 2,500 patients using MEND.
Among those patients was a baby with an apparent umbilical hernia. Through MEND, Dr. James Gill was able to instruct the baby’s mother on how to test if the hernia required attention in a physician’s office or an emergency room. Dr. Gill’s guidance verified the baby did not have a hernia and was able to save the mother a “trek for her [the baby] to see her family physician.”
Telemedicine provides similar urgent assistance to stroke victims in rural New Mexico. A stroke victim may need surgery or blood-thinning medication to avoid head trauma. Determining when those are necessary is complex and best handled by specialists. Unfortunately, the only level-1 trauma center in New Mexico is in Albuquerque, which is only accessible by helicopter for rural patients who need help quickly.
Fortunately, telemedicine allows specialists in Albuquerque to connect with physicians in rural hospitals to make life-or-death decisions swiftly and without costly helicopter rides. Neurosurgeon Howard Yonas, one of those specialists, said, “You can talk to the patient, you can see the patient, you can ask the patient to do certain tests…. All of that can happen within about 30 minutes of the time they come [into the emergency room].”
Using telemedicine to link specialists to where they are most needed also reduces emergency-room congestion. In 2016, the Eastern New Mexico Medical Center in Roswell reduced the percentage of stroke victims transferred to Albuquerque from 50 percent to 12.6 percent. Another hospital in Roswell reduced transfers from 50 percent to 6 percent.
In terms of policy, imagine if stroke victims could not access a specialist because they weren’t in Albuquerque. Or if stroke victims in Texas couldn’t access specialists in New Mexico due to state borders. Or if that infant’s mother had been told to wait five or six weeks to find out if her child had a hernia. On what grounds can we justify denying these patients timely care?
When policies that increase access to medical care are thwarted by state boundaries or quibbling over quality, lives are put at risk. I say the more access the better. A long list of veterans and others desperately awaiting care would agree.
Raymond March, Ph.D., is a research fellow at the Independent Institute and an assistant professor of economics at San José State University.