For decades, state authorities have been blocking this concept.

 

And, for decades, folks like me have been pushing back.  Explaining that it’s in everyone’s best interest.  (Here’s one of my first blog posts about telemedicine- with its use for CHF [Congestive Heart Failure] individuals.)

 

There are more than 100 million citizens at risk of heart attacks, strokes, and the like due to their hypertension.   One or two simple devices is all it would take to protect them- by collecting, monitoring, and sending their data to a telemedicine center- or their doctor’s office. 

 

Diabetes is yet another ailment calling for such activity.  Since, poorly controlled diabetes leads to kidney failure, cardiac events, among others.  And, diabetes is rampant across the USA.

 

It’s not just because our health care system is geared to cure and treatment rather than the maintenance of patient health.   It’s because telemedicine could allow physicians from a different state to monitor, diagnose, and provide medical advice to patients.  Between the state regulatory authorities worried about control and the physicians in the state paranoid about competition, telemedicine has been blocked for at least three decades.

 

Sure, telemedicine is operational.  There’s Ochsner.  Which operates a telemedicine network in Louisiana.  Theirs is a digital hypertension system- complete with blood pressure cuffs, digital infrastructure, and digital health care analysts.  And, it took using their own cash, since there wasn’t any reimbursement code for telemedicine practice.  Nor, did Ochsner have any reliable data that patients would use and value the system or that doctors would be willing to participate.

 

Of course, Ochsner has such data now.  Within 3 months of inception, 2/3 of those participating had their blood pressure under control.  That compared favorably to the less than 1/3 under control who relied on conventional medical practice.  Which led Ochsner to expand the program to include pregnant women (this involved a wireless scale, blood pressure cuff, and three urine tests which report via app to the medical center). along with those suffering from diabetes.

 

The big thing is the BlueCross/Blue Shield (Louisiana) is now on board- covering the blood pressure cuffs and remote monitoring for Ochsner.  Unfortunately, Medicare still balks at the concept.

 

Federal law still restricts Medicare reimbursement for telemedicine, unless the services are provided to patients in a rural setting (and that is only because of dire shortages of physicians).   Not to mention the fact that rural hospitals have been closing (the closing rates doubled in the past five years or so).  Congress is removing the ban- disease by disease though- having approved telemedicine for hospital-based stroke patients and for kidney patients (end stage renal disease) who undergo treatment at home in urban and suburban locales.  And, CMMS (Centers for Medicare and Medicaid Services) has even approved a billing code for remote physician “check-in” calls with patients.  (Of course, they say this ISN’T telehealth.  (Hmm.  Certainly sounds like that to me.)

 

But, that rural America exception is how  AveraCare provides such services in 30 states.  (In particular, they provide remote emergency care.) While their docs never once touch their patients (kind of hard to do if you are miles away),  they use remote controlled cameras, microphones (which allow for breathing sounds to be monitored), and, of course,  computer screens.  Nurses and PA’s (physician assistants) in the emergency room are the ones providing ‘hands on” activities, under the direction of the remote physician.

So, in 2020, some 15 million folks are receiving some sort of telemedicine care.  The big problem seems to be patient acceptance.  It’s kind of hard to be enamored of the system’s “webside” manners. 

That just means that we have to start training physicians to deliver virtual care.  Things like public speaking, presentation, remote monitoring, engaging the patient to use their smart phone to take and transmit photos, are all “new” things that must be addressed to convert patient acceptance.

But, there still is an earthquake coming.  You recall that AveraCare system I mentioned above?  It routinely allows patients to be put on ventilators. 

Moreover, it’s no longer just rural hospitals that are running short of medical professionals.  Hospitals in New York City, Boston, Chicago, Nassau County, among others are unable to keep up with the demands of the pandemic.

Telemedicine is the answer.  It means that physicians elsewhere can answer the call.  More importantly, it means that some physicians will be able to keep working through the pandemic, since they won’t be directly at risk of contracting Covid-19.

Consider the Providence Health System.  1200 beds across their system (7 Western states) are populated with patients suspected of Covid-19.  Four clinical trials.  11000 tests a day. Without telemedicine, they’d be unable to cope. (They even interface with home-based patients, using AI, to determine their needs and receive care.  Which, of course, reserves their acute care resources for those in dire need.)

How did that happen?  CMMS has issued waivers, allowing cross-state licensing of physicians.  They’ve also approved funding for telehealth measures.

This approval also permits Providence to remotely monitor ICU (intensive care units),  to direct care by nurses and PA’s.  Pulse oximeters (oxygen sensors) and digital thermometers can alarm when a patient needs direct intervention.  And, in emergencies, physicians from their chain of hospitals can jump in and effect care via telehealth.

And, now, telemedicine is being advanced to treat folks in New York City and Nassau County (NY) hospitals, among others trying to deal with the deluge of patients- and the risks to the emergency patient staff.

So, there may be a silver lining to this pandemic.  It’s bringing telemedicine into general practice- affording our health professionals the ability to amplify their abilities to treat patients effectively.