Telemedicine: Providers Eye Long-Term Payoff

The next wave of telemedicine, in which providers are now making investments, will retool the entire healthcare industry, according to a trio of experts in the field.

As telehealth visits for patients are growing exponentially across the country, health systems and hospitals are gearing up for the broad application of telemedicine technology across the entire care continuum.

Dozens of initiatives are already underway in areas such as pharmacy, nursing, telestroke assessments, and the creation of "digital communities" centered on patients with specific conditions, according to Win Vaughan, acting president of virtual health services at Englewood, CO-based Catholic Health Initiatives.

"From a consumer-driven perspective, everybody in healthcare is going to have to offer these kinds of services," Vaughan says.

A virtual pharmacy program at CHI is paying off for the health system in several key metrics, including patient satisfaction and reduction of adverse medication incidents, and has tremendous potential in terms of cost avoidance such as readmission reductions, he says.

The virtual pharmacy model at CHI features pharmacists who process medication orders remotely. "We can have a pharmacist who works from home or from a centralized hub. They have remote access to electronic medical records… They just do order management. They don't get distracted with other activities."

The program has freed up time for hospital-based pharmacists to work closer with physicians and their patients, Vaughan says. "If you have pharmacists doing clinical activities with patients from admission to discharge, you avoid adverse reactions and pharmacists can make recommendations to the doctors who ordered the drugs."

CHI has begun assessing the financial impact of the virtual pharmacy program, and the early data is promising, he says. At a 65-bed hospital in the health system, CHI estimates it is saving at least $87,000 per month by having a virtual pharmacist review medication orders. "You have to make some assumptions about how much an adverse drug event costs the health system," he says.

Until payment reform catches up with telemedicine retooling in the healthcare industry, financing will be the main obstacle to growth, Vaughan says.

"We're trying to find ways to generate enough revenue from the virtual health programs that we can make them sustainable… That's the tricky part," he says, adding the virtual pharmacy program is a sustainable model but telehealth patient visits with specialists and "third-party" healthcare providers are financially problematic. "In telehealth visits, we are restricted to working with entities that have responsibility for total cost of care."

CHI expects its telemedicine retooling efforts, which include a budding initiative to have highly skilled nurses work remotely in a care management role, to generate significant returns on investment. "As people realize this is having a huge impact downstream, the payment piece will fall into place… We are trying to get experience in this space because we think it is going to keep on growing."
 
A Long-Term Perspective
The leadership team at Philadelphia-based Thomas Jefferson University Hospitals views telemedicine retooling as an essential investment in its future, according to Judd Hollander, MD, associate dean for strategic health initiatives.

Jefferson has spent about $20 million on a long-term strategy toward telemedicine-based initiatives over the past four years, he says. "We're going to lose money now because it is uncompensated care. We're going to make money later because it will be compensated care. We realize we are taking a financial hit now, but we're going to be ready when the reimbursement catches up."

Jefferson has a telehealth visit partnership with Boston-based American Well, which is bullish on telemedicine retooling, according to Chief Marketing Officer Mary Modahl. "The top areas where we see return for hospitals are: reducing readmissions and lowering the cost of post-surgical follow-up care; attracting new patients to the health system by offering the most convenient care; and, for those under ACO contracts or other quality- or population-based payment mechanisms, keeping patients within the system so they can coordinate all their care needs."

In addition to the American Well partnership, Jefferson has launched several telemedicine initiatives, including a virtual rounds program launched in November 2014, Hollander says. At Jefferson, virtual rounds feature a video link that allows family members to participate remotely when a physician or other caregiver meets with a patient at one of the health system's hospitals.

"Every hospital patient gets asked whether they have family members who they would like to be included in virtual rounds. We call the families to make sure they can download the technology on their computers. We've done 300 of those virtual rounds so far. … The patients love it."

Telemedicine retooling is an example of the kinds of long-term investments health systems and hospitals are making as the healthcare industry shifts from service volume to service value, Hollander says.

"I view telemedicine as an infrastructure cost, just like [electronic medical records]. You've got to invest in your infrastructure to take care of your patients five years from now… In the end, everybody is going to be doing telemedicine for some segment of their system of care. Over time, more and more patients will get comfortable with it. Telemedicine is high value at low cost, but we're not trying to push it on anybody. We're just trying to give people options to get care the way they want to get it.

'The Next Quantum Leap in Healthcare'
"The entire healthcare system, both in the United States and globally, is on the verge of a major transition," says Anita Goel, MD, PhD, chairman and scientific director at Nanobiosym in Cambridge, MA.

Goel, who has several academic and research organization affiliations such as serving as an associate of the Harvard University Department of Physics, is a pioneer in the field of nanobiophysics. She describes this new scientific discipline as the merging of physics, nanotechnology, and biomedicine.

"The next quantum leap in healthcare will come with the convergence of these silos, not through advancements in any one of these silos," she says.

At Nanobiosym, Goel has added a dash of information technology to nanobiophysics to develop Gene RADAR. The cloud-connected, mobile device is designed to give healthcare providers the ability to diagnose disease in real-time during a patient visit. Gene RADAR is 10 times cheaper to build than existing "bulky machines" weighing" several hundred pounds and requir[ing] costly infrastructure," she says. Each Gene RADAR diagnostic test costs one-tenth the price of tests conducted with existing technology, she says, adding that the device is on the verge receiving its first approval from the federal Food and Drug Administration.

"You save money, you save time, and you save logistical costs. The overall impact on the healthcare system is tremendous. When you wait longer to get into therapeutics… the greater the chance of advancement of illness and costly complications."

Gene RADAR is an example of how telemedicine and a shift to less costly medical technology can achieve monumental change in the delivery of healthcare services, Goel says. "The next generation of healthcare will be decentralized, mobilized, and personalized. Instead of the blunt instruments of the past, we will be giving patients more precise medications and therapies."