"Patients and doctors don't have to drive as far and some monitoring can be done in the patient's home without even needing a nurse visit. And it provides patients with access to specialists they may not get otherwise," Wechsler. adds.
Telehealth providers at UPMC extend beyond physicians and to nurses and midlevels, such as the telehealth remote monitoring program. In this area, Wechsler explains, UPMC uses in-home telehealth equipment to monitor congestive heart failure patients' key measures, provide reminders, and communicate with patients.
The benefit of this approach is the nurses can monitor the patients proactively, identify potential health risks, and encourage the patient to comply with physician's orders. UPMC also has plans to expand this to other conditions such as COPD, diabetes, and hypertension.
"By using telemedicine and leveraging nurses we can also serve multiple practices at one time and support our medical home model," Wechsler adds.
Though the effort to reduce readmissions will eventually pay dividends, hospitals and health systems in states without telehealth mandates must decide how to bill for services.
"We use midlevel providers but consider the visits telemedicine consultations. Reimbursement for telemedicine consults is limited and thus not all visits are covered by insurers," Wechsler says. "However, the financial viability of telemedicine consults must be considered in the overall scheme of costs and savings. The time and costs associated with travel for patients, time efficiency for physicians, and lower costs associated with testing at community hospitals should be included in any cost-benefit analysis."
Though telehealth has been in practice for years, training for mid-levels, nurses, and physicians is still evolving as new tools are developed. Wechsler says staff telehealth training is an area in need of more attention nationwide. UPMC offers some training to medical staff to help them work with the digital peripherals, but much of the education centers on questions to ask to guide diagnoses.
Telehealth training is a unique area of interest for Central Ohio Primary Care, a 225-physician primary care corporation in Columbus. The group practice is piloting the use of HealthSpot, Inc.'s Care4 Station, a community-based remote care kiosk that enables a physician and another provider at the location with the patient to work seamlessly as one with the patient, explain Robert Stone, MD, a member of the executive committee at Central Ohio Primary Care, and William Wulf, MD, corporate medical director for Central Ohio Primary Care.