Telemedicine's future: Not what it used to be
Applicability depends on your business mix
You've heard that telemedicine is the wave of the future, but so far it seems more like low tide than a tidal wave. However, while the necessity to use telemedicine may not be knocking at your front door, it's likely much closer than you think.
"Home infusion is already using telemedicine to a large extent, by virtue of the fact that you can now dial in to devices and download information from pumps that are in the home," notes Loretta Schlachta, RN, MSM, SHP, CHE, clinical director and principal with Strategic Monitored Services, a New York City-based disease management company using telemedicine to deliver health care. (See Home Infusion Therapy Management, July 1997, p. 93.)
However, for home infusion providers, remote pump technology is about as far as telemedicine has penetrated the industry.
"In the strictest sense of the word, home infusion providers are already doing telemedicine in terms of transmitting information," says Schlachta. "But when you talk of conducting a virtual visit using a video piece, I don't believe that is being done by home infusion providers anywhere."
Telemedicine shows little progress
That's not to say home infusion is lagging behind the rest of the health care industry. In fact, consults between nurses or physicians and patients are not anywhere near where they could be.
"For years we have had televised operations and had medical students see what is actually happening in the operating room, and we have held education for surgeons using a multipoint system," says Joseph Little, EdD, director of teleme di cine and strategic information systems for the Cancer Institute of New Jersey in New Brunswick. "But if you define telemedicine as a consult between a physician or nurse and a patient, that is not coming by leaps and bounds."
The reason is simple: reimbursement.
"Unless you are in a physician-deprived area, it is difficult to obtain reimbursement for this," notes Little.
But don't be so quick to put telemedicine aside as some far-fetched idea whose time hasn't come.
"HCFA [Health Care Financing Administra tion] has come up with guidelines so in 1998 or 1999 they can conduct trial reimbursements in physician-deprived areas," according to Little.
Some payers prove amenable
HCFA isn't the only payer looking at telemedicine, according to Schlachta. In fact, some payers are already opting to reimburse for telemedicine visits.
"Individual home health companies have gone to their major payers and proposed, 'I'll charge you one-third the rate for telemedicine visits,' and payers have said yes," she says. "Individual methodologies have been worked out with payers."
Schlachta points out that if an infusion provider deals with a particular payer for a majority of reimbursement on a per-visit basis, it's simply a matter of pointing out that a telemedicine visit will cost $20 compared to $65 for an in-person visit.
"As long as you assure a certain level of quality, payers have been amenable," she says.
But providers working on a pay-per-service reimbursement system aren't those who will benefit the most. It's providers working in a capitated environment who can benefit immediately, as they have an incentive not to go to the home. Also, people in geographic areas that are remote or impossible to get to depending on weather and other factors could benefit from the technology, even if only seasonally.
As usual, though, reimbursement will be the driving force.
"Prospective payment coming to home health will drive this," says Schlachta. "People can put these devices in and avoid physical visits in the home."
Such video capability would provide particular benefits for a home infusion provider.
"You can simply avoid certain visits," according to Schlachta. "The only thing you can't do is hands-on, but you can monitor infusions and walk people through administration of their own medications."
"In talking to home infusion nurses, they like having this technology available as a troubleshooting function," says Little. "If there is something wrong with equipment, rather than dragging themselves to a patient's house at midnight, they can take a look at it."
If you're trying to reduce costs by limiting the number of in-person visits you have to make, the cost of such technology becomes a major factor. Since telemedicine first hit the streets, the technology has become quite affordable.
Strategic Monitored Services currently uses a small box that contains a modem and video camera and sits on top of a patient's television set. It costs just $699.
"This allows you to put it in homes for use as needed for any type of monitoring, such as observing patients, pumps, or reactions to certain medications, and it's easily learned," notes Schlachta.
A two-button remote control - a green button starts the teleconference and the red button ends it - ensures a minimal learning curve for patients. There will be a learning curve for you, though. Issues such as training staff, implementation, policies and procedures, quality assurance, and certification and standards (available from the American Nursing Association) must be addressed. And disease-specific telemedicine standards may not be far off.
"We're currently working with the Cancer Institute of New Jersey for oncology disease management using a home telemedicine-based approach, and that would include delivery of chemotherapy," says Schlachta.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content