Telehealth: betting the minimum or all in?

By Daniel Theobald, Chief Innovation Officer, Vecna, and Amanda Baldi, Director of Marketing, Vecna, For For the Record

Telehealth is a rising trend: patients prefer it, physicians need it, the market demands it, insurers reimburse for it – and the technology has been proven and is ready to scale. Typically, it’s driven by the physician with a finite amount of time who sees this solution as a way to either see more patients or to see patients in treatment when needed, not when dictated by rounding schedules. However, as effective as these remote care consultations are, healthcare organizations are not yet fully on-board – therefore not maximizing the financial benefits. Leaders at healthcare systems need to support end-users and scale up their telehealth programs and start deriving value for the entire organization.

Placing Bets on Telehealth

Extending Physician Reach

Trends indicate a shortfall of 130,600 physicians by 2025. This trend will intensify the shortage of specialists and healthcare facilities in rural areas.[i] Physicians will need to build in travel time for clinical or surgical rotations for the catchment areas of whole healthcare systems which are often spread out over large geographic areas.

Telepresence solutions have a positive impact in emergency department and intensive care units where specialists are often required on short notice.  For example, a Vanderbilt University Medical Center (VUMC) physician could remotely monitor a patient with sepsis at a small community hospital via teleICU, and order a timely treatment, further preventing clinical deterioration and escalation of care through a transfer to VUMC. The virtual intensivist would use a VGo, at the patient’s bedside to discuss care plans with the nurse and family, while placing orders into the partner hospital’s electronic medical records to facilitate immediate care.

The squeeze on clinical resources can in part be attributed to demographic trends. Our aging population is creating a larger number of high-acuity, high-risk patients with a high incidence of chronic diseases who require more frequent attention from specialists.[ii]

University of Cincinnati College of Nursing is using telepresence robots at their partner retirement communities and skilled nursing facilities to address the care needs for a changing demographic. In initial use, they have more resident-reported “well days” per month. The standard of healthcare can be maintained without in person visits and has allowed this innovative leader to be more efficient with their limited resources.

Improving Outcomes

One of the most important benefits of telehealth is in the lowering of costs as measured by reductions in hospitalizations, readmissions, and lengths of stay. The potential for financial savings exists in the ongoing management of chronic disease. Approximately 100 million Americans with chronic disease account for 75% of healthcare expenditures.[iii] El Camino Hospital has implemented the VGo as part of their telehealth initiative to improve quality of care and patient experiences. In an effort to reduce readmissions, the patient takes the VGo with him when they are discharged. The VGo connects the patient in the nursing home with his or her physician.

Making the Most of Reimbursements

Telehealth

The Centers for Medicaid and Medicare have put a structure in place to guide the adoption of telehealth. Forty-eight states and Washington DC provide reimbursement for some form of live video in Medicaid fee-for-service.[iv] More than one third of these reimburse for remote patient monitoring (RPM). While many of these states still have restrictions on telehealth reimbursement policies, such as patient setting or origination site, technology type, geography and provider type, there is no denying that the stage is set for adopting telehealth services – especially in the private sector. Private insurers are actually promoting their telemedicine services.[v] It’s a competitive advantage.

Patient Satisfaction

For those providers who are already using telehealth, they’re finding that, in fact, telehealth improves patient satisfaction. For example, Children’s Specialized Hospital uses a VGo, a small mobile robot that provides two-way audiovisual communication to improve patient care and experience. The telepresence robot allows patients’ parents to log in and visit their children virtually at any time during their stay. Physicians also gain critical access – at any time and from anywhere- ensuring continuity of care for children with complex conditions. As a result, patient satisfaction and the standard of care are improved, while reducing the overall cost of care and hospital re-admissions. Not only is this significant for patient satisfaction reimbursements – which account for over 30% of a hospital’s reimbursements – it also provides a competitive advantage.

Going All In: Best Practices in Implementing Telehealth

Patients and physicians are ready for telehealth, and improved outcomes are being realized by healthcare facilities around the country. So, what’s holding healthcare leaders back from mass adoption of telehealth solutions? As with any new technology, the most important thing is just to start. Here are 8 best practices in lowering barriers to taking the first step and scaling up your telehealth programs.

  1. Start Small: Choose one area where you can make the biggest impact and then scale to other areas of your practice. Identify the biggest areas of constrained resources, with the largest proponents of live video consult. Application areas might include: video rounding for traveling physicians or remote specialists, rural hospital consultations, skilled nursing care, or rapid second opinions in ICU or ED.
  2. Identify Critical Features: Find a simple and affordable solution that offers the ability for physicians to move around, zoom in, and snap photos that can then be uploaded to a patient’s health record. Some telepresence solutions also have a USB port for high-powered cameras for remote dermatological or wound care consultations. This solution should also allow a physician to log in without requiring a resource at the other end to receive the call.
  3. Account for All Costs: To ensure the best ROI, ensure that the solution you choose includes the cost of the device, subscriptions, warranty, and support. This way, you won’t encounter any surprises down the line.
  4. Make Good on Reimbursements: Start with a small application that is certainly covered by reimbursements and then use that reimbursement to scale up and purchase additional devices or licenses.
  5. Minimize Reliance on your IT Staff: Reduce the workload for your IT department by using an encrypted solution that connects over pre-existing WiFi networks.
  6. Turn Clinical Early Adopters into Solution Champions: The key here is making sure the solution is easy to learn, easy to use, and device agnostic. Once those features are secured, physicians who are already using telehealth technologies will be your best advocates in scaling up your telehealth program.
  7. Increase Patient Adoption through Marketing: Studies indicate that public awareness of telehealth technologies may lag behind availability.[vi] ROI can only be achieved if you have a solution that is used and accepted by physicians and patients. As we’ve seen with patient self-service solutions, any technology that’s used for patient-facing communication must be well marketed. Use digital signage in waiting rooms, email marketing, and patient portals to educate patients about telehealth.
  8. Appoint a Telehealth Expert: To take their telehealth programs to scale, some early adopters of telehealth are creating a new role for a telehealth expert and advocate. By committing a resource to coordinating telehealth services, you’re making a value statement and demonstrating to your patients and physicians that you’re serious about supporting improved patient satisfaction, reducing physician fatigue, and improving outcomes.[vii]

The Winning Hand: Compassionate Care

The methods by which we engage with our health IT infrastructure are still being refined. However, telehealth is one way to use IT to improve the patient-provider relationship. Care and compassion are available on the go. So, while the value of telehealth can be quantified by patient satisfaction scores, competitive edge, reimbursements, and improved outcomes, scaling up the adoption of these solutions is one way to restore the trust between patients and providers, reduce clinician burnout, and make healthcare a little bit more human.

[i] https://www.aamc.org/download/426260/data/physiciansupplyanddemandthrough2025keyfindings.pdf

[ii] http://americas.nttdata.com/Industries/Industries/Healthcare/~/media/Documents/White-Papers/Trends-in-Telehealth-White-Paper.pdf

[iii] http://americas.nttdata.com/Industries/Industries/Healthcare/~/media/Documents/White-Papers/Trends-in-Telehealth-White-Paper.pdf

[iv] http://cchpca.org/sites/default/files/resources/Telehealth%20Policy%2050%20State%20Factsheet%20Full%20-%20Sept%202016%20FINAL.pdf?utm_source=Telehealth+Enthusiasts&utm_campaign=7d53608b79-Issue_in_Focus_CCHP_Releases_50state_report9_27_16&utm_medium=email&utm_term=0_ae00b0e89a-7d53608b79-267651085

[v] http://www.thinkbrg.com/media/publication/689_Younts_Telehealth_Whitepaper_20150916.pdf

[vi] http://www.healthcare-informatics.com/news-item/survey-41-percent-consumers-aren-t-aware-telemedicine

[vii] https://news.vanderbilt.edu/2016/08/18/telemedicine-usage-increasing-rapidly-for-many-service-lines/