Is Telehealth an Option for Surgeons?

March 27, 2019

Telehealth is one of the fastest growing sectors in the healthcare field, according to the American Hospital Association. In 2013, 52% of hospitals utilized some form of telehealth/telemedicine. But in the last 2 years, we have seen a steep increase in utilization as the brick and mortar model of healthcare is being challenged, and some might say is slowly becoming obsolete.
Based on a study published in Forbes in 2013, telehealth utilization was expected to grow nearly 1700%, from an estimated 250,000 patients that year to an estimated 3.2 million patients in 2018. As patients are becoming more proactive in their healthcare delivery choices, sub-specialty and surgical focused telehealth platforms are starting to come online as well; however, many are still bulky, cumbersome and generally only offered as an integrated service within an existing hospital or multi-specialty clinic system.
Today’s patients are demanding easier access to healthcare, greater flexibility and more telehealth/telemedicine options; and even sub-specialty care is starting to move towards the mainstream. Over 75% of patients prioritize access to care over the need for an in-person interaction with their provider, and 7 out of 10 patients are comfortable communicating with their provider via text, email or video. Private payors are starting to realize this as well and many states have enacted “parity” laws, which generally require health insurers to cover services provided via telehealth, just as they would a walk-in visit. Telehealth law is a rapidly changing field and an ever moving target; with much legislation having been passed in 2018, including new standardized CMS coding for e-Visits, and several new bills currently awaiting review in 2019.
Originally, telehealth/telemedicine was developed as an outreach tool, offered only by larger hospital systems and primarily used to connect with the approximately 20% of patients who live in rural or remote areas. Today, telehealth/telemedicine allows providers to connect with their patients anywhere, at any time; breaking down more than just the distance barriers to healthcare.
Telehealth/telemedicine services may be provided via secure live video and audio connections, or as a “store ad forward” platform, utilizing asynchronous video telecommunication. New telehealth/telemedicine platforms offer the same HIPAA compliant and HL-7 certified communication as is utilized in an office based or hospital practice. The current state of technology has allowed for dramatically improved physician-to-patient communication and has paved the way for virtual home care, a new and novel way of dealing with health and wellness. A component of telehealth/telemedicine-virtual home care- allows a patient to communicate with their healthcare provider remotely via a computer, tablet and/or other hand held electronic device, even a cell phone – negating the need for bulky and cumbersome remote telemedicine monitors, computers and other equipment.
Not only can virtual home care be more convenient for the patient, but it may also be more cost effective for both the patient and the provider. E-visits cut down on the expense of travel and lost wages for the patient, as well as reducing office overhead by allowing providers to evaluate and treat patients from the comfort of their home office.
Telehealth/telemedicine may offer another key advantage for providers, as this new found “home time” may also help with an epidemic that we are currently facing in the field of medicine- physician burnout. Some reports suggest as high as 50% of physicians will encounter “burnout” during their career. More and more is being asked of us as providers in terms of volume and increasing documentation requirements.
Virtual medical care offers numerous benefits to the patient and provider:
– Directly links patients to their provider(s)
– Creates access to sub-specialists regardless of geographic location
– Avoids unneeded time off of work for patients and allows more home time for providers
– Saves money by eliminating travel costs and time off work
– Allows convenient scheduling of appointments, including after hours, nights and weekends, and provides 24/7 virtual access (particularly with store and forward systems)
– May reduce missed appointments and hospital readmissions
– Enhances patient satisfaction by identifying and treating problems early
– Allows providers to triage lower acuity patients and treat these patients remotely, particularly post-operative patients and routine rechecks
– Allows patients to play a more active role in the management of their healthcare
– Potentially helps decrease physician burnout by allowing providers to practice from a home office part-time
– May decrease office overhead for providers
Healthcare Finance and Becker’s Hospital Review reported on a new study in the Annals of Vascular Surgery which suggests that telemedicine not only improved satisfaction within post-operative visits, but boosted quality of life for patients recovering from vascular surgery1. Patients were provided with a telemedicine app and other in-home monitoring tools to track their vital parameters. They also completed questionnaires on their emotional wellness and satisfaction. Care managers reviewed all of this data on the telemedicine platform daily, which allowed them to intervene and answer patients’ questions about symptoms, wound care, prescriptions, scheduled appointments with physicians, and modified care plans. Compared to the participants who received standard treatment, patients in the telemedicine group scored better on measures of their physical function, mental health and role limitations due to physical health problems.
Telemedicine is also transforming the delivery of orthopedic care. A recent report in Healio Orthopedics Today highlighted how virtual care could help both patients with post-surgical complications as well as those whose recovery efforts are progressing well, but would like to “touch base” and connect with their surgeon or other healthcare professionals.
In summary, today’s healthcare consumers are not only looking for more affordable and higher quality healthcare, but are expecting levels of convenience similar to what is available in the retail and banking sectors. Telehealth/telemedicine meets this demand. To that end, physicians will increasingly be encouraged to embrace these new virtual care technologies.
As of today, virtual care for the surgical provider or sub-specialist is still somewhat in its infancy, as new platforms are constantly being developed and improved upon. The Deloitte 2018 Survey of US Health Care Consumers and Physicians have found that lack of reimbursement, complex licensing requirements (for multi-state practices), digital security concerns and the (potential) high cost of implementing these technologies have led to slow adoption. However, with a shift towards value-based reimbursement, both small clinics and large health systems will need to work towards helping providers adopt and use virtual care tools effectively to improve patient access and cut healthcare costs.
References: 
American Hospital Association. Trendwatch. January 2015
PricewaterhouseCoopers Health Research Institute. New Health Economy. April 2014
NTT Data, Trends in Telehealth (2014)
ObamaCare, Doctor Shortage to Spur $2 Billion Telehealth Market, Forbes. December 2013
1Results of Telehealth Electronic Monitoring for Post Discharge Complications and Surgical Site Infections following Arterial Revascularization with Groin Incision; Presented at the SVS 2018 Vascular Annual Meeting, Boston, MA, June 20–23, 2018.
*The views and opinions expressed by our guest bloggers are those of the authors, and do not necessarily reflect the views of KarenZupko & Associates, Inc.

 

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