The problem with telemedicine is not vision or technology, it’s distribution and billing
Who said you have to see your physician in-person? The evolution of telemedicine is making it easier to receive healthcare services from the comfort of your own home. Through simple telecommunicating technology, like video-chat, email, and smartphones, telemedicine offers immense benefits for both patients and medical providers.
As a growing number of Americans — nonetheless, their physicians, are becoming tech-savvy, it seems only natural that telemedicine would play a major role in healthcare of the 21st century.
So why hasn’t it become more of a common practice?
One of the reasons is fear. According to the Affiliated Workers Association, 70% of physician-visits can be conducted using telemedicine, yet less than one percent is. Medical providers worry that telemedicine will have adverse effects on healthcare, like obstructing the physician-patient relationship. Those who subscribe to this school of thought believe that telecommunication is deeply impersonal, and therefore cannot replace in-person consultations.
However studies have found that consultations over video-chat and phone can actually be more effective. Patients tend to be more honest in the comfort of their own home, and are more willing to disclose information about their lifestyle and health to their physician using telemedicine as opposed to in-person. They are also likelier to ask more embarrassing questions when telecommunicating with their physicians. So instead of straining physician-patient relations, telemedicine can actually improve them. The more honest a patient is, the more their physician can get to know them and better diagnose any health irregularities they may have.
Many physicians also fear that telemedicine will be more of a burden than a benefit. The average physician doesn’t spend their time sitting at a desk. They are moving around from patient to patient, running tests and filling prescriptions. Blocking out time in their busy day for telemedicine is not ideal for most medical practices, considering that their revenue depends on patient-volume. The more appointments a physician can squeeze in a day means more money for that practice. It’s an inefficient healthcare model that discourages physicians from investing in the actual success of their patients’ health.
But it’s the norm.
However telemedicine can be as mobile as physicians, and can also help physicians see more patients in a day. Mobile apps like Curogram have made it possible, and easier for physicians on-the-go. Through Curogram, physicians can respond to questions from their patients vis á vis sms on their very own mobile phones, and whenever is convenient for them. Other mobile apps with video-chat platforms offer similar flexibility for physicians, such as the option to accept or decline requests from patients depending on the physician’s availability. Consultations, in-person and virtual on average last around 10–15 minutes. If a physician finds extra time in-between appointments, or even has no-shows, they can turn their focus on telemedicine.
Physicians don’t have to make time for telemedicine — they can fit it in with their existing schedules.
Physicians also fear new technology. Medical providers are well known for being stuck in the 20th century when it comes to technology because they have yet to adapt to the new digital age. Physicians are especially wary of telemedicine, because of its limitations. Unlike in-person consultations, telemedicine has the capability of breaking and potentially leading to miscommunication with the patient. If, for example, a video-consultation between a physician and patient gets disconnected, and as a result that patient takes his medicine wrong, the physician could be liable for a malpractice lawsuit.
However patients find that directions given over telemedicine platforms — such as e-mail, sms, and over vide-chat, are clearer than in-person. After all, physicians are infamous for their bad handwriting. A RAND study found no increase in clinical misdiagnosis or errors in treatments for those using telemedicine.
Physicians have nothing to fear. Telemedicine is intended to complement the work that physicians are already doing — not replace it. Today, telemedicine is predominantly used in the Intensive Care Unit, where specialists monitor patients from remote “launch centers”. These specialists give direct orders to nurses and physicians in the ICU. Patients in the ICU are typically in critical care, and need to be closely monitored.
Telemedicine plays a large role in the success of ICUs that utilize telemedicine by having specialists alert on-site physicians when, for example, a patient’s heart rate marginally goes up. People in the ICU may not catch these slight changes, but telemedicine can. Remote specialists can then inform the ICU physicians and have them take action early, and potentially even rescue the patient.
Medical providers are also finding telemedicine to be extremely effective in rural areas. For Americans living far from any medical practices, telemedicine helps bring healthcare to them in their own home. Patients can arrange consultations with their physicians over the phone, or video-chat from their own computer. A routine visit no longer has to entail missing school or work for rural patients who have to drive upwards of 200 miles just to get to their physician. Telemedicine encourages patients to be more engaged in their healthcare by making it accessible, and convenient.
Telemedicine doesn’t have to be reserved just for intensive care, and rural patients. It has the ability to benefit all those that have the option to use it. So why isn’t it used more often? Vision and technology isn’t the problem with telemedicine. Instead, billing and distribution are the greatest obstacles in the expansion of telemedicine. They’re also interlinked.
There is no common standard to be reimbursed for telemedicine. Regulations for the billing of telemedicine services differ state-by-state, which poses a significant problem for a form of healthcare that transcends state-lines. Only a handful of states have regulations for private-payer telemedicine, and the regulations within those states differ from one another. Some states prohibit telemedicine from offering more affordable costs to patients because of outdated laws that mandate the same cost of coverage regardless of how it is delivered. Some prohibit reimbursement for telemedicine altogether. Until there is a widespread standard for reimbursing telemedicine services, expansion, or distribution of telemedicine will be greatly hindered.
Distribution has also proven problematic with telemedicine because of resistance from medical providers. While some physicians oppose telemedicine out of fear that it will hurt their patient-relationships, as mentioned earlier, those who are interested in telemedicine have a struggle integrating it in their medical practice because of limited insurance coverage. Medicare and Medicaid only cover telemedicine services for members living in rural areas, and even then typically limited to specialty care and not primary. Patient-advocacy groups like AARP have pushed Congress to expand Medicare coverage for all telemedicine services. They have however faced resistance from Congress who worry that telemedicine can increase Medicare expenses, even though telemedicine has been proven to be more cost-efficient than more traditional modalities. However the more educated health professionals become of telemedicine, the greater the demand for it. Insurance coverage will eventually have to follow suit.
The first hurdle that telemedicine will need to tackle is billing. It’s undeniably a major incentive for medical providers, and without proper methods for reimbursement will continue to hinder its distribution and expansion. As proponents of telemedicine continue to push Congress and insurance companies in general to expand coverage, its vision and technology will continue to develop. Sooner than later, medical providers and their insurance counterpart will need to adapt and be forced to find solutions for the problems with telemedicine today in order to join the digital age.
