How Telemedicine is Transforming Senior Health Care

How Telemedicine is Transforming Senior Health Care  


By Julie Potyraj – Guest Blogger

Polly, age 78, and suffering from obesity-related health issues, is sitting on her sofa on a snowy afternoon. At 3 p.m., it’s time for her wellness appointment. Polly turns on her iPad (supplied by her doctor’s office), and sees her physician’s face smiling back at her. The doctor has already received information on Polly’s blood sugar levels, heart rate, and blood pressure via a remote monitoring system that sends the data directly to his office. After chatting for a bit, Polly shows the doctor a mild rash on her arm. Upon evaluating the condition—made possible by high-definition video conferencing equipment—her physician recommends a round of antibiotics and transmits a prescription to the local pharmacy. Thirty minutes later, the appointment is over, and Polly hasn’t left the warmth and comfort of her home.

This scenario is not from some futuristic film—it’s telemedicine, and it’s gaining momentum in health care settings across the world. Also referred to as telehealth, telemedicine is defined by the industry as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.” This is more than just a trend; 52 percent of hospitals already use remote technologies to deliver clinical services.[1]

The Impact for Seniors and Health Care as a Whole

For aging adults with mobility and transportation problems, telemedicine can offer a welcome respite from in-person office visits. Frequent doctor’s appointments become less of a strain for seniors as well as their caregivers, who often must take time off work to accompany their loved one.

The early intervention afforded by telehealth also helps prevent unnecessary emergency room visits and hospital readmissions. While this is good news for patients themselves, it also helps ease the burden on America’s health care system by improving efficiency and reducing costs. Consider the following real-world examples:

  • An Illinois-based skilled nursing home chain is using telemedicine to minimize readmissions and eliminate unneeded ER visits, saving the health system hundreds of thousands of dollars annually. Through this program, which involves using video teleconferencing to enable bedside evaluation by board-certified physicians, approximately 81 percent of patients using the technology can be treated on-site.
  • In North Carolina, telemedicine is helping seniors diagnosed with diabetes, COPD, and heart failure remain in their homes and out of the hospital for longer periods. This is accomplished by monitoring these patients remotely in between skilled nursing visits using specialized telehealth technologies.

Medicare is Warming to Telehealth

In 2015, the Centers for Medicare & Medicaid Services (CMS) delighted telemedicine advocates by adding seven new payment codes covering additional telehealth services, such as annual wellness visits and psychotherapy. However, there is still work to be done. In an effort to help all Medicare recipients enjoy the benefits of telemedicine, organizations such as the American Telemedicine Association continue to actively encourage CMS and Congress to eliminate the arbitrary restrictions that limit coverage.
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[1] American Hospital Association. The Promise of Telehealth For Hospitals, Health Systems and Their Communities. Trendwatch. January 2015.


Telehealth for Seniors

Skilled Nursing Facility using telehealth

Home, But Not Alone

The ATA’s Home Telehealth special interest group was launched 16 years ago – and the progress made in that field has been spectacular.

Telehealth was originally envisioned as a way for rural patients to get access to specialists, but now it’s widely used in many other ways:

 Remote patient monitoring has really come of age. For example, the University of Arizona health system uses telehealth technology to provide at-home monitoring of prospective heart transplant patients who are waiting for a donor match.

Remote medication management helps ensure that patients adhere to the appropriate dosages and schedules. Research shows that medication non-adherence is a factor in more than half of hospital readmissions – and nearly twenty-five percent of all nursing home admissions.

Telehealth for care transitions reduces errors as patients move to different care settings: hospital, skilled nursing facility, home care, etc.

The bottom line is that thousands of patients are getting expert care without having to physically visit a specialist or PCP. As they grow comfortable with the benefits of at-home monitoring, they’re much more receptive to acute care consultations when the need arises.

The laws governing home health vary widely from state to state, and that’s why there are efforts underway to create standards and protocols for remote home care.

Without telehealth, most communities will fall short of their population health management goals. Patients with multiple chronic conditions need ongoing education and observation where they matter most: in their own homes.



Converging Megatrends

In a recent blog, Dr. Joseph Kvedar from the Center for Connected Health discussed how three “megatrends” are combining to give new impetus and immediacy to telemedicine.

The first trend is the sea change in healthcare reimbursement – from volume to value. For decades, many patients seeking treatment for severe heartburn were put through a dizzying array of tests and scans to rule out possible heart problems. Those tests were obviously of little value in determining the root cause of the problem. We now have a healthcare system that’s moving steadily toward a more sensible reimbursement paradigm.

The second trend is that consumers are getting increasingly smarter about healthcare costs, provider options, and ways to get personally involved in their own well-being. Thanks to the Internet, patients are much more engaged in the process rather than being passive participants.

Finally, most patients are now completely comfortable with mobile technology, which makes them much more receptive to innovations in connected health. Smartphones, tablets and touch screens are now commonplace – and most patients have no problem with a specialist on the East Coast assessing their condition in the Pacific Northwest. Most patients now readily agree that a provider’s time zone is far less important than the timeliness and quality of treatment.

When powerful megatrends merge, the world is forever transformed. For instance, when cheap oil and modern logistics came together, FedEx and Walmart became pioneers in the global supply chain. In similar fashion, the confluence of three megatrends is fueling telemedicine. Like the rivers that feed the Mississippi, these trends are creating a movement that can’t be stopped.

Bullish on ACOs

Accountable Care Organizations and telemedicine have a common purpose: expanding access to improve care. According to a recent CDC report, 80% of adults who visit the ER do so because they lack access to other providers. Telemedicine not only provides that access, but it makes it easy to provide the post-visit patient monitoring so vital to the ACOs’ main mission: managing high-risk populations.

Telemedicine-driven ACOs hold a lot of promise, but that didn’t stop several Harvard University pundits from prematurely proclaiming their demise.

In a recent Wall Street Journal article titled “The Coming Failure of Accountable Care,” Harvard prof Clayton Christensen and colleagues painted a gloomy picture. But they were quickly countered by Joseph Kvedar, MD from the Center for Connected Health. After careful reflection, we agree with Dr. Joe.

In Kvedar’s view, the Harvard gang incorrectly labels ACOs as “latter-day health maintenance organizations.” But HMOs were driven primarily by health plans that lacked the tools for delivery reform. In contrast, ACOs are provider-driven, offering a fresh vision for population-based care delivery and reimbursement.

The Harvard gang feels that doctors’ attitudes won’t change enough to make ACOs successful. But Kvedar notes that many physicians are weary of the fee-for-service grind, and are very receptive to things like shared savings, bundled payments and full capitation.

However, Kvedar and the Ivy Leaguers agree on one key point: to fulfill the promise of ACOs, patient attitudes must dramatically change. Many Americans still don’t feel compelled to hit the gym and avoid the cheeseburgers to rein in the cost of preventable, chronic illness. Millions of us cling to a sedentary lifestyle, then expect the healthcare system to fix us. That mindset will obviously have to change for ACOs to have a fighting chance.

Christensen and his Harvard associates are like baseball fans who write their team off in May. But, hey, the season is still young – and both telemedicine and ACOs have bright prospects. Dr. Kvedar feels that they could be the healthcare equivalent of the Baltimore Orioles: an unexpected success. Telemedicine-empowered ACOs can win the hearts and minds of physicians – and they can make money.

As every sports fan knows, you just have to believe.

State of Excitement

A bill before the Indiana state legislature requires Medicaid to reimburse for telemedicine services provided to all rural health clinics.

A bill before the Indiana state legislature requires Medicaid to reimburse for telemedicine services provided to all rural health clinics.

For those of us who’ve been waiting for meaningful telemedicine legislation at the state level, there’s cause for celebration. Eight states and the District of Columbia have already introduced bills this year aimed at expanding telemedicine reimbursement from both Medicaid and private insurers. And the ATA estimates that another ten states will follow suit in coming months.

Much of the proposed legislation draws heavily from the ATA’s recommendations for what constitutes a model telemedicine bill. This succinct document gives lawmakers some statehouse-friendly language on how to expand telemedicine coverage by health plans, HMOs, Medicaid and home health.

Legislators in Mississippi and New Mexico deserve kudos for introducing two new bills, presumably to widen the discussion to ensure that the final bill is comprehensive. The bills would require all health insurance plans to cover telemedicine services to the same extent as those provided in-person.

In Florida, House bill 499 would require both health insurers and Medicaid to provide coverage for telemedicine services, and would extend Medicaid telemedicine coverage to home care. A bill in Indiana goes a step further, requiring Medicaid to reimburse for telemedicine services provided to all rural health clinics.

Proposed legislation in the state of Washington would greatly reduce hospital compliance requirements when granting privileges or associations to telemedicine physicians. And the South Carolina bill has language requiring both individual plans and HMOs to provide telemedicine coverage.

It’s looking like 2013 will indeed be a watershed year for far-reaching telemedicine legislation. You can feel the momentum in states both red and blue. Politicians are very sensitive to the winds of change, so now’s the time to contact your state legislators and keep the pressure building. This could be our year!