Delay the 911 call for telemedicine. The Federal government is administering CPR through the 2008 ARRA Stimulus bill and Reform measures and processes deemed worthy of funding. Telemedicine’s technology platform supports a layman’s linkage of telemedicine (also known as telehealth) and ehealth initiatives. This may be a method of infusing oxygen rich blood into telemedicine projects and funding; it demeans the ability and value of telemedicine as a stand-alone strategy supporting clinical strategic growth.
The compatibility of these strategies is apparent on the surface. If congruence supports increased funding and attention to telemedicine so be it. Unfortunately, health system capital access is severely limited moving into 2010 capital budgeting. Added to the ever-present and ever increasing information technology budgets whose rationale ranges from additional CMS quality indicators to JCAHO reporting, telemedicine’s value is present – just no one is one the other end answering.
Mr. Bell has made the call; no one is on the other end to say hello.
Market Opportunity and Response
Telemedicine’s market opportunity is based on the provider’s ability to establish an appropriate service and technology foundation including, but not limited to:
· Centralized telemedicine planning and IT support;
· Single platform for all business units, service lines, and centers of excellence;
· Consistent and uniform linkage between health systems or providers as host site
and designated access points within care delivery systems;
§ Standardized contractual linkage between system(s)/provider(s) and designated care delivery systems and/or business units.
Product definition and business model are still in their infancy. Clinical industry leaders include psychiatry and home health services. As early adopters of the technology, the service model for both lends itself to (a) self reporting, (b) episodic evaluation, and (c) longitudinal treatment and management. Typically evolving within a business unit or service line in response to need or apparent opportunity, most current programs are silo driven – lacking overarching organizational support systems or business models resulting in barriers to utilization, reimbursement, and market growth.
Defining telemedicine’s market opportunity is difficult because in most cases telemedicine is a tactic to create new access points within integrated systems of care and not stand alone strategies. To date, product development and corresponding business models have not been established. Inpatient, outpatient, and ambulatory volumes have been forecasted with an assumption a percentage of outpatient volume is applicable for a telemedicine application and a percentage of hospitalization could be minimized by home assessment. Assuming telemedicine supports market expansion and penetration strategies for the system and constituent business units, the geography can be defined as commensurate with the broader goal.
Canadian Models
Canada’s telemedicine model’s vision is: “Better care through timely access to secure health information when and where it’s needed.” As of 31 December 2008, the Canada Health Infoway (Infoway) approved investment in 276 projects nationwide or $1.457 billion. The model is based on the concept of telehealth services linked via ehealth strategies to an electronic medical record housed by the physician and health system – linking the “front line of care” to the back office, or medical record, using ehealth technology.
The linkage of telehealth or telemedicine and ehealth technology is apparent. Telemedicine solutions are incorporated into screening, diagnosis, treatment, care management, and education.
The essential element is that the Canadian health systems aside from the issues Americans hear and Canadians utter concerning lack of access, nationalized employment of physicians, etc., has intentionally designed an information highway – a system of care, designed to link all access points a consumer would have. Aside from the design, the government has mandated the funding and initiated projects. All the while, Americans continue to debate the pros and cons of healthcare reform and limit overall investment in the systems and technology that would improve the overall health of the nation, reduce hospitalizations, and move one more step toward the consumer taking control for her/his care.
Answer through healthcare reform?
The Centers for Medicare and Medicaid Services reimburse only limited physician services rendered, most frequently, in geographies considered underserved by traditional clinical services. Credentialing guidelines are not standardized nationwide; the ability of telemedicine to cross county, state, and even continental boundaries questions the appropriateness of hospital (or system) credentialing.
Mid-July, the House Ways and Means Committee approved inclusion of telemedicine provisions in their national health care reform legislation. Rep. Mike Thompson (D-Calif.) proposed measures that remove current technology barriers. Measures included:
· Streamlines telemedicine consultation process enabling physicians to retain credentials regardless of patient’s home address.
· Establishment of an advisory panel for centralized government telemedicine recommendations.
· Expansion of Medicare covered telemedicine services – inclusion of stand-alone kidney dialysis centers.
All issues are not resolved; this is a legislated start to moving the telemedicine agenda forward.
Next Steps
Cardiology implemented transtelephonic monitoring of holter monitors – electrode based monitors of electronic impulses of the heart, over twenty years ago. Technology is beginning to catch up to medicine’s needs. There are outstanding telemedicine supports for geriatric populations, preventative health, and wellness programs. The traditional business model provides investment funding for those services that result in new revenues. Check out reimbursement for geriatric medicine, screenings, and preventative health.
Moving the system of care agenda forward through projects like the medical home model, pay for performance, or bundled pricing. The real barrier is the notion that care can be delivered via technology. For all the effort to create technology solutions the real issue still faces the industry – can providers (and physician extenders) provide quality care when not face to face?
Leave a Reply