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What’s Holding Telemedicine Back?

Kathryn Mackenzie, for HealthLeaders Media, August 12, 2008

There has been a lot of news recently about the increased use (and future growth) of telemedicine. One report predicts the market for telemedicine devices and services will reach nearly $2 billion in less than five years. "New wired and wireless broadband networks are saving time and costs in the medical environment. They allow specialists to remotely triage, diagnose, and monitor medical cases by viewing data and images conveyed wirelessly to their locations. They also enable specialists to access medical records and medical reference material that are germane to a specific patient's case," say analysts at market research firm Pike & Fischer.

Researchers at the University of Missouri estimate that the U.S. could save $1.5 billion in healthcare costs if health plans encouraged patients with chronic diseases to engage in frequent telemedicine visits with their doctors.

In yet another study, researchers at the University of California San Diego Medical Center found that stroke patients in remote locations receive more accurate treatments through the use of telemedicine consultations than with telephone consultations. In this case, researchers define a telemedicine consultation as including real-time two-way audio, video, and digital imaging. In fact, they say correct treatment decisions were made in 98% of telemedicine consultations compared to 82% of telephone consultations.

Despite all of the reported benefits associated with practicing telemedicine, there are still major obstacles that have prevented adoption of this technology. Lack of reimbursement, the high cost of purchasing and installing the equipment, and confusion surrounding the legality of providing patient care across state lines are among the most commonly cited reasons healthcare providers say they have chosen not to invest in the technology.

Karen Rheuban, MD, president-elect of the American Telemedicine Association recently cited funding as one of the greatest barriers affecting the dissemination of telemedicine when she appeared before the House Agriculture Subcommittee on Specialty Crops, Rural Development, and Foreign Agriculture. In her testimony, Rheuban urged Congress to commit to a greater level of funding support. "Current Medicare reimbursement policies and uncoordinated agency definitions of rurality" have kept providers from adopting this technology at a greater rate, she says.

Even though providers continue to push for increased funding, the government doesn't seem to be in any rush to give it to them. In its response to requests that that Diabetes Self-Management Training and critical care services be added to the list of Medicare telehealth services, the Centers for Medicare and Medicaid Services recently recommended against adding those services to the telehealth list, saying "We have no evidence suggesting that the use of telehealth could be a reasonable surrogate for the face-to-face delivery of this type of care."

Still, the industry did receive a bit of good news in late June when the House of Representatives passed legislation expanding the list of Medicare telehealth originating sites, adding hospital-based renal dialysis centers, skilled nursing facilities, and community mental health centers to the list of sites that are eligible for reimbursement. Advances in broadband technology have also increased the scope of providers who can afford to practice telemedicine. With a high-speed Internet connection and a computer, even the most rural hospital operating on a shoestring budget can have access to specialists that were previously unavailable to them.

The reports predicting that the practice of telemedicine will save the healthcare industry billions of dollars while vastly improving the quality of patient care may eventually prove to be prophetic. Before that happens, however, most experts agree there is going to have to be broader financial support from payers in both the private and public sectors.


Kathryn Mackenzie is technology editor of HealthLeaders magazine. She can be reached at kmackenzie@healthleadersmedia.com.
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