Progress is being made in the developing area of telemedicine, but there is a lot more to do, according to a health expert who believes it should much more widely utilized across the country.
Scott Haller, a fellow at the Pioneer Institute in Massachusetts, is the lead author of a study that focused much of its attention on the organization's home state and concluded it is lagging behind in telemedicine. But the study gathered information to deliver a snap shot on what is happening nationally.
Telemedicine has a patchwork of different rules and regulations, not surprising given the state-based structure of insurance and Medicaid and more generally the network-based health system.
Haller noted the federal government has not stepped in to promote telemedicine enough, although the Medicare program was something of a pioneer in the area, albeit in a limited way.
"It is a game changer," Haller told Patient Daily. Telemedicine could save hundreds of millions of dollars a year while bringing top care to those in remote communities, in nursing homes, and in prisons, he said, citing a study by the group representing this area of the health industry.
"Telemedicine isn't going anywhere, so we benefit by embracing it early and seeking more opportunities to utilize its savings to help bend the cost curve in Massachusetts," Haller told Patient Daily.
"Current statutes and regulations inhibit the growth of telemedicine by placing unnecessary restrictions on where and how it can be practiced, when they should be encouraging pilot programs," he said. "Both doctors and patients stand to save on costs and convenience."
According to Haller, the American Telemedicine Association (ATA) estimates the annual, national savings of telemedicine, were it implemented properly, at $1.6 billion. Connecting rural emergency rooms to other hospitals rather than transferring patients could save $537 million. Connecting correctional facilities, $270 million, and nursing homes, $800 million.
ATA, obviously strong advocates for the development of telemedicine, also finds that chronic disease management could have costs reduced by 10 percent, while hospital in-home programs can save 19 percent.
Haller is critical of his own state of Massachusetts, stating that it is one of only two that doesn't mandate telemedicine for Medicaid patients.
HIs organization's study, "Dialing up Telemedicine," urged the state to more aggressively embrace new technology that allows remote access in many areas of health care.
"Until now, Massachusetts has been tentative when it comes to reimbursing for telemedicine as part of Medicaid and other programs," Pioneer Institute Executive Director Jim Stergios said in a statement following publication of the study. "There's more we can do to capture the lower costs and higher quality outcomes it can provide."
The most common form of telemedicine is live interactive appointments via videoconferencing. But "store and forward" allows patients or other doctors to communicate with a physician via email or a web application.
This approach is more commonly used in fields like dermatology, radiology or pathology, where tests are often interpreted after an appointment, Haller said. Remote patient monitoring allows patients to remain at home while a device such as a blood sugar or heart monitor relays information to a doctor.
The Pioneer Institute, in its study, noted that Medicare was among the first programs to reimburse for telemedicine. But it was limited and many state Medicaid programs are based on Medicare's model.
States are, however, beginning to loosen restrictions. Half the states now allow patients to join appointments from home.
Twenty-three states require that private insurers reimburse for telemedicine at the same rate as an in-person visit, while nine others have some form of reimbursement parity legislation.
According to Haller, strict reimbursement parity creates an incentive for insurers and providers to participate in telemedicine but forfeits much of the savings, which average $126 per acute care visit, according to one study.
