Patients, providers, and the advent of telemedicine

By Sarah Willett, SVP, Commercial Banking

Learn more about the future potential of healthcare - telemedicine.

With its video and digital platforms, telemedicine allows patients to receive treatment from world-class medical professionals without traveling to urban or out-of-state hospitals. Doctors review labs, vital signs, IV bag settings and changes to skin and pupils — all without being physically present at a patient’s hospital bed. Patients benefit from targeted care, quick diagnoses and lower costs.

Mercy Health’s splashy new center
A new 125,000 square foot center exemplifies how telemedicine is taking off. Mercy Health opened the first comprehensive facility devoted entirely to off-site care. The $54 million state-of-the-art facility near St. Louis has 330 staffers, including board-certified emergency department and trauma center doctors and nurses credentialed to give orders and provide consultation.

Patients benefit, because through the SafeWatch and Virtual Hospitalists programs, Mercy staffers “see” patients around the clock at small hospitals that lack 24/7 doctors and specialists. A Wall Street Journal article on telemedicine said Mercy’s virtual intensive care unit (ICU) program resulted in a 35 percent decrease in average length of hospital stay and 30 percent fewer deaths than anticipated.

Rural patients benefit from virtual care
When it comes to rural hospitals, the Centers for Disease Control and Prevention (CDC) says 51 percent of patients are 65 or older (versus 37 percent of those in urban hospitals). These patients tend to be on Medicare, avoid travel barriers and choose to remain close to home. Local hospitals may not be equipped to address these patients’ complicated health issues, but virtual care can often manage the burden and can lead to them being discharged to their rural-area home in lieu of another hospital or a long-term care facility.

With that in mind, Mercy Health launched a Home Monitoring pilot program, in which they communicate with 250 rural patients with complex illnesses who were recently discharged from the hospital to their home. Per a CNN Money story, patients transmit their vital signs and talk to Mercy nurses at the Virtual Care Center twice a week through an iPad. Mercy doctors check in daily with those who are high-risk.

How telemedicine can solve the doctor shortage
Telemedicine can do more than monitor patients and help them avoid hospital transfers; it can also address the shortage of “intensivists” (critical care physicians with specialty training). The Journal of the American Medical Association (JAMA) says the supply of intensivists will meet only 22 percent of demand by 2020.

This shortage will pose a problem for nursing home patients, who are often hospitalized for heart failure, pneumonia and urinary tract infections — despite the fact these are all considered avoidable admissions. The University of Pittsburgh Medical Center (UPMC) says skilled nursing transferred one-quarter of Medicare patients to hospitals in 2011 costing $14.3 billion, of which $8 billion was not necessary.

Telemedicine requires fewer onsite doctor resources and leads to more efficient usage of off-site specialists. That fact, coupled with the news that nursing homes will be penalized for readmissions starting in 2018 (just like hospitals are now), indicates the virtual care is ripe for expansion.

The Pittsburgh Post-Gazette writes UPMC launched a subsidiary named Curavi, which will sell electronic stethoscopes, heart monitors and cameras to nursing homes. Geriatricians will provide consults on nights and weekends, and nursing homes will pay for the service.

And Avera opened a virtual care center in Sioux Falls, South Dakota, launched partly with $8.8 million from Centers for Medicare and Medicaid Services (CMS). Avera’s geriatric doctors virtually treat patients at 30 continuing care retirement centers (CCRs), managing 90 percent of urgent care visits via eLTC (virtual long term care).

How Ddctors and Medicare view telemedicine
Telemedicine is growing, and more states are permitting prescriptions to be written after virtual exams. But not all physicians favor this. Some doctors believe a hands-on exam has a lower chance of misdiagnosis and a better chance of appropriate tests being ordered.

And Medicare doesn’t always pay for virtual care. Medicare does pay for rural residents to access virtual care for home monitoring, and for patients to receive treatment from urban hospitals in a rural doctor’s office, clinic or hospital setting.

Virtual care is beneficial, because it leads to lower costs and improved treatment for elderly residents, rural hospital patients and others. This is important, given that the American Heart Association (AHA) says the cost of treating cardiovascular disease alone (heart disease, stroke, high blood pressure) will rise from $317 billion in 2012 to $804 billion in 2020. Luckily, telemedicine is here, and it’s bringing seismic change to the healthcare industry.