Telemedicine payments are gaining ground
Technological advancements spur new interest
Despite the fact that 25% of elderly Americans live in medically underserved areas, current regulatory restrictions prevent Medicare from reimbursing for telemedicine treatments related to over 90% of outpatient services.
Seeing the potential in terms of both improving patient well-being and cutting health care costs, the Health Care Financing Administration is underwriting a major telemedicine field research project it hopes will prove the concept’s viability.
Meanwhile, look for new rules next year increasing telemedicine reimbursement rates.
In Congress, House Commerce Committee chairman Tom Bliley (R- VA) also is pushing lawmakers to expand Medicare’s telemedicine coverage to include health services provided through video conferencing and long-distance phone line transmission of digital photographs, X-rays, and other patient data.
While the Washington policy-makers do their thing, private sector engineers and entrepreneurs have been pushing telemedicine’s technological envelope forward. As such, smart practices will make a place for telemedicine on their long-range strategy agenda, advise experts.
The current state of the telemedicine market shows that the fastest-growing segment of the technological market is end-user devices for home care.
Meanwhile, efficiency improving virtual teleconferencing systems, once only available to major hospitals, are now within the reach of individual practitioners.
Apollo Telemedicine, in Falls Church, VA, for instance, recently announced a new program that permits individual physicians joining its eHealthStat network to consult physician-to-specialist, potentially reducing the time it takes to put a diagnosis and treatment plan together.
"The idea is to create a virtual hospital environment where physicians can interact with other specialists over the Internet so they can get on with their primary business of diagnosis and treatment more easily," says Apollo spokesman Mark Newburger.
Major advances are also being made in the remote controlled instruments and medical sensing devices for patients.
Miami’s American Medical Supplies (AMS), for instance, has various specialized medical devices operating in over 1,700 telemedicine-related sites in 41 countries. Notes AMS president Mark VanderWerf, "Right now we can give patients a dedicated device to remotely read out each of the normal diagnostic measures such as blood pressure, pulse rate, temperature, etc. The patients now have to buy these devices themselves. But, once Medicare starts paying, the device will just come as a free part of the service of monitoring you at home."
E-mailing sounds
Among the items in its catalog, AMS currently sells four types of remote-control stethoscopes, including its Phone-Steth, which the company says passes high-quality heart and lung sounds over telephone lines for real-time assessment of patients.
One stethoscope, the e-Steth, connects to the sound card of a patient’s personal computer to digitize heart and lung sounds as well, creating a simultaneous multimedia phonocardiogram, which is automatically e-mailed to the physician.
Like other vendors, AMS is developing remote-controlled versions of all the various diagnostic instruments often used by providers. It, for instance, has a remote-controlled scope that a nurse can insert in a patient’s ear, nose, or mouth while a doctor at a remote site views the resulting image on a computer screen.
Those images and data also can be stored so the reviewing physician can look at the procedure at his or her convenience.
Government and private researchers also are perfecting the ultimate telemedicine specialty — remote-controlled surgery.
In fact, remote-controlled surgery has been successfully performed by SRI International of Menlo Park, CA, operating under a contract with the U.S. Armed Forces. And the prototype system, Telepresence Surgery System, is being perfected as a teaching tool at the Uniformed Services University of the Health Sciences in Bethesda, MD.
Initially intended for combat situations, physicians located away from the fighting use robotic surgical instruments equipped that mimic their movements equipped with 3-D vision monitors to operate on wounded soldiers still on the battlefield.
One private firm, Computer Motion of Goleta, CA, has used this research to develop what it calls a "smart" operating room where surgeons never touch the patients. Instead, they use a voice-controlled robot to make surgical incisions.
"You never have to worry about your hand shaking or slipping, while the enhanced dexterity and precision reduces patient pain, trauma, and recovery time. These new minimally invasive procedures just are not possible without robotic assistance," maintains Robert Duggan, Computer Motion’s CEO.
Last July, Computer Motion announced the first successful robot-assisted surgery on a major organ — the removal of a gall bladder by a surgeon at the University Hospital of Gasthuisberg in Leuven, Belgium. Since then, surgeons have also used its robots in over 500 endoscopic radical prostate removal procedures.
"If you can operate the robot from 10 feet away, then you can operate it from 10 miles or 10,000 miles away with the proper data connections," says VanderWerf.
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