From its virtual care center now under construction, the Missouri-based healthcare system says it will be able to extend telehealth services to patients across the entirety of its 42-hospital system 24/7 through audio, video, and data connections.
If there was any doubt that telemedicine could be the next big thing in healthcare, St. Louis-based Mercy erased it this week with an announcement that it will build a $50 million virtual care center in the nearby town of Chesterfield, MO.
The 42-hospital system, which bills itself as the nation's sixth largest Catholic healthcare system, broke ground this week on a four-story, 120,000 square foot telemedicine mega-building that, when finished, will be the command center of the health system's already large telehealth program.
"The center will bring together the nation's best telehealth professionals to reach more patients, develop more telemedicine services, and improve how we deliver virtual care through education and innovation," said Lynn Britton, Mercy's president and CEO, in a statement.
Mercy's journey into providing telemedicine began nine years ago, says Tom Hale, MD, executive medical director for the organization's telehealth services. The provider has acute and specialty hospitals in four states: Missouri, Kansas, Oklahoma, and Arkansas. It offers 75 different telemedicine services to more than 3 million patients, and as Hale told me, Mercy's telemedicine component of care is only expected to grow.
Investing in Telemedicine
Hale says that in addition to the many telemedicine services Mercy provides, even more are being piloted.
"Our biggest effort is with pediatric psychiatry," says Hale. He illustrates his point: "We have a pediatric psychiatrist out of Springfield. There is a family who takes care of seven foster children, and all seven kids had to be treated. It was a two-day event to care for all seven foster kids. Can you imagine?"
Those kids, says Hale, can now be treated over the course of hours, not days. That access to care, at the right place, and the right time, is why telemedicine holds so much promise.
Mercy's virtual care center is scheduled to be complete in 2015 and to be able to house 300 physicians, nurses, specialists, and IT staff. From the virtual care center, which hale calls the "brain" of Mercy's telemedicine operations, clinical staff will be able to extend care to patients 24/7 through audio, video, and data connections across all of the organization's locations.
Telemedicine is one of the fastest growing segments of patient care. It is especially good for connecting physicians to care for patients in rural areas, where there are shortages of nearly every specialty, including primary care physicians. It also helps to alleviate shortages of specialists, no matter where patients live.
Telepsychiatry, for example, is one way that hospitals are dealing with not only the need for mental health providers for children, but also the rise in psych patients in emergency departments. With the click of a button, a remote psychiatrist can be available in an Austin, Texas, emergency room.
Hale hopes Mercy will eventually get to that point, too. "Telepsychiatry would be helpful," he says. "With 50% of our business being in rural areas, we have a significant problem getting behavioral health providers."
Telemedicine's Reimbursement Challenge
Despite Mercy's sunny outlook on the future of telemedicine as a growing component of how it cares for patients, Hale is realistic about the payment barriers that exist.
"We've been able to demonstrate effective care, but we haven't moved the needle with payers, nationally," says Hale. "We have a lot of contracts with local insurers and directly with employers. We have 300,000 patients who are in a gain-share or shared savings model, so locally we've made an impact, but not nationally."
Reimbursement for telemedicine services varies from payer to payer and from state to state. Some states have tried to push through laws mandating that payers treat a telemedicine visit just like an office visit, but so far, the payment issue is at best a patchwork.
Hale says the reimbursement challenges are likely to remain until healthcare has made a full transition from volume to value. "If payment methodologies were different, telemedicine would be exploding,"
"Fee-for-service is a 'feed-the-beast model'; population health management is a 'grow the village' model. What we will see over time is the breaking of that barrier," he says.
Virtual Doc Visits Under Fire
Yet another challenge to telemedicine is the concern that a virtual visit lacks the same quality as an in-person visit. Really? Have you been to the doctor lately? A quick 10–15 minute visit isn't what I, or most physicians, for that matter consider high quality care.
For organizations leery of taking the plunge into telemedicine for fear that patients won't like it, Hale says relax.
"In my experience, patients are very accepting," says Hale. But he cautions that there is a need to train physicians on making sure that the patient's experience is good.
"We teach doctors how to best use the technology and manipulate it," Hale says. "The whole key is training. Physicians need to understand that this is a relationship, and once they're reminded this is not a video visit, but a patient visit, it becomes better after about four to five visits."
Hale is hopeful that telemedicine is a ticket out the fee-for-service model, but he doesn't think that it will lead to "Stepford doctors practicing medicine over television."
"I think that telemedicine as a whole is augmentation not replacement," he says. "It will change it in a fashion that will allow for much greater access to care. This is a possible solution to our quality and cost issues, but only if it's used to maintain the relationship between caregivers and patients by providing access to care that they didn't have before."
Jacqueline Fellows is a contributing writer at HealthLeaders Media.