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A key, rising issue of concern in the United States’ healthcare scenario is the fact that residents of rural areas have very limited access to healthcare. This is an issue that affects groups such as military veterans and more than 560 tribes of Native Americans throughout the country.

The healthcare scenario in Rural America
The situation of healthcare in rural areas is impacted by many factors that are not present in more central, urban areas – these include limited access to broadband internet and to technological arrangements in general, as well as a significantly high patient-to-provider ratio. As per the National Rural Health Association (NRHA), remote rural areas have 39.8 doctors per 100,000 individuals, as compared to the ratio in urban areas, which is 53.3 doctors per 100,000 people.

There are numerous other inequalities in the healthcare system in rural parts of the United States. As per the NRHA, treatment for mental health conditions is extremely low in rural areas. This is because of a lack of available mental health specialists, and a deep-rooted sense of stigma surrounding mental health problems, which prevents patients from seeking help. As a result, suicide is twice as likely among the youth in rural areas.

Remote areas also display a higher prevalence of heart diseases and diabetes; in addition, usage of tobacco is also much higher in rural areas as compared to urban areas. Added to these issues is the fact that the per capita income in rural areas is nearly $9200 less than it is in urban areas. Combined, all these factors point toward a healthcare pandemic in the rural areas of the United States.

Using Telemedicine as leverage
Admittedly, telemedicine is not a panacea that will bring about an end to all the healthcare problems plaguing rural America. However, telemedicine does have the capability to even out the patient-to-physician ratio and improve rural area residents’ access to healthcare. It is a feasible alternative healthcare option for those living in the more remote areas of the United States.

As per a Health Data Management article authored by Greg Slabodkin, the Government Accountability Office (GAO) conducted interviews with Medicaid officials from 6 different states, and the findings revealed that levels of telemedicine use a higher in rural areas as compared to the more urban areas. The auditors from the GAO discovered that in the rural state of Montana, for example, telemedicine is used to connect patients to specialists not only within the state but out-of-state too.

Medicaid programs, unlike Medicare, are run by the state – as such, they are subject to state laws regarding the practice of telemedicine. Owing to this, the reimbursement of services provided via telemedicine depends largely on the policy of a particular state.

As per a recent report by the Center for Connected Health Policy, this is a brief summary of the situation for Medicaid’s telemedicine reimbursement across the United States:
46 state Medicaid programs offer coverage for live video
9 state Medicaid programs provide coverage for telemedicine services provided via store-and-forward
14 state Medicaid programs provide coverage for RPM (Remote Patient Monitoring)
Just 3 state Medicaid programs (MN, MS, AK) cover all three telemedicine types
26 state Medicaid programs reimburse a transmission or facility fee (or both).

In order to conduct thorough research on telemedicine, it is essential to have a reliable source of information.

The following are three excellent sources for keeping tabs on Medicaid’s telemedicine coverage:

The National Telehealth Policy Resource Center. They have created a highly useful interactive state-wise map of telehealth policy.
State Medicaid agency websites. If you don’t know the website for your state’s Medicaid agency, here is a complete directory.

The American Telemedicine Association. The ATA regularly tracks policy updates for telemedicine and publishes quarterly reports on the latest news and situation of state legislation for telemedicine.

You can find the latest report here.

Factors that impact Medicaid’s telemedicine reimbursement. The rules and regulations for telemedicine reimbursement are different in each state and are not always completely clear. The following are some factors that can have an impact on your reimbursement for telemedicine via Medicaid:
Eligible providers (NPs, PAs)

Health Services covered
Is cross-state medical licensing permitted?
Is a pre-existing provider-patient relationship required?
Are there any location-specific limitations on providers or patients?
The kind of fee that needs to be reimbursed (facility, transmission, or both)
CPT codes that are applicable

Although many states are working on the expansion of reimbursement for telehealth, others are still set on containing and limiting the delivery of telehealth services. While each state has its own unique laws, rules and Medicaid program policies, there are certain similar trends which come to light if several policies are scrutinized. For instance, Medicaid reimbursement for live video is more frequent than reimbursement for remote monitoring of patients and store-and-forward.

The time period between 2013 to 2015 saw steady growth and upward trends in reimbursement for store-and-forward and remote monitoring of patients; however, this growing number has currently reached a sudden halt, and remains the same as it was at the time our last report was published, in July 2015. However, there are some promising signs – although some states are not moving forward on telehealth, others are progressing in this regard.

In Washington, for example, the Medicaid program now provides some reimbursement for services delivered via store-and-forward. On the other hand, the Medicaid program in Oklahoma has stopped reimbursement for store-and-forward. These differing policies point at a wider issue regarding the unpredictable nature of policies throughout the country.

Some key findings are as follows:
• As it was the previous year, 47 states and Washington DC offer reimbursement for certain types of live video through Medicaid fee-for-service. Iowa’s Medicaid program established that they do offer reimbursement for live video; however, the telemedicine policy for Utah is not available, which means Utah cannot be included in the list of states that provide reimbursement for live video. Owing to this, the number of states that offer reimbursement for telemedicine services remains the same as last year.

• As mentioned previously, Oklahoma’s Medicaid program does not provide reimbursement for store-and-forward anymore, while Washington’s Medicaid program now does so. So, the number of states that reimburse for store-and-forward continues to be a total of nine. This number does not include states that provide reimbursement only for teleradiology.

• Since July 2015, no changes have been observed in state Medicaid programs’ provision of reimbursement for remote patient monitoring; it continues to be in effect in 16 states.

• Five Medicaid programs, for the states of Washington, Minnesota, Alaska, Mississippi and Illinois, provide reimbursement for all three, although this is subject to certain restrictions. This has increased by one since July 2015.

Upon first impact of hurricanes Harvey and Irma, the primary healthcare priority was the physical health of those affected by the disasters. However, in the wake of the hurricanes, the mental well-being of the residents also became a chief concern for healthcare providers. Not only have telemedicine services be used to connect storm-affected persons to traditional healthcare providers, they are also being used as a vital method for catering to behavioral health needs.

“Once the immediate physical danger has passed, then people start to experience the traumatic feelings of realizing that perhaps they’ve lost their home or maybe they’re in great financial distress,” Dr. Sylvia Romm, medical director at American Well, pointed out. “That’s where the therapist can come in and help them move forward with their lives.”

In the aftermath of the hurricanes, behavioral health is one of the free services being provided by American Well and others.

Telemedicine is an appropriate and effective method for the provision of aid to those affected by natural disasters, as many of the victims are displaced from their homes in an emergency situation. “You have such large numbers of people who’ve been displaced,” Romm explained. “Even if they had a therapy relationship, chances are they wouldn’t be able to access them any longer.”

Larry Gleit, executive vice president of specialty care at MDLive, explains that this is so because, in addition to patients, healthcare providers have also been displaced by the disaster. “Part of why telemedicine becomes so important is that all of the providers live in the community have just experienced the same natural disasters.”

In addition, Gleit pointed out that a scarcity of behavioral health providers is already being felt. “In general, there’s a dependency and need to use virtual care,” he stated. “The need becomes compounded in situations like this.” During the weeks following the hurricanes Harvey and Irma, MDLive provided people in affected areas telemedicine visits free of cost.

Drones were also employed by the American Red Cross, for the very first time, to gain an idea about the extent of damage in parts of Texas, and to obtain an accurate assessment about which areas were most in need of assistance.

Integrating current telemedicine techniques into your healthcare practice can provide you multiple advantages. These include reduced costs of healthcare, a more efficient practice, increased revenue, and provision of easier access to healthcare for your patients, all resulting in healthier, more satisfied patients who wish to remain under your care.

Convenience is the magic word in today’s world, and this holds true in the field of healthcare too. The addition of telehealth to your practice will help your patients obtain quick yet customized care, without having to deal with setting appointments, wasting time, and shouldering the cost of in-person visits.

The option of virtual visits can make accessing healthcare easy for patients who are housebound, live in distant locations, or are unable to take time off their jobs.

Virtual monitoring and consultation, along with electronic storage of data, decrease the service costs of healthcare to a great extent, increasing cost-efficiency for healthcare providers and patients, as well as insurance companies. In addition, telemedicine helps cut down on avoidable visits to the ER for minor issues and reduces the transport costs for routine checkups.

By using telehealth, fast and appropriate specialist access can be provided to patients residing in distant or rural areas. The specialist to the rural patient ratio in the United States is greatly imbalanced; for every 100,000 patients in remote areas, there are just 43 available specialists.

As a result of this shortage, patients have a hard time obtaining consultations in life-threatening circumstances or for rare/chronic diseases. In addition, they often have to travel long distances to meet appointments and receive care.

Patients’ commitment to their own care is vital for improving health and reducing costs. As pointed out by Jan Oldenburg (Ernst & Young Senior Advisory Services Manager) to Healthcare IT News, “[t]he high cost of disengaged consumers affects everybody.” Telemedicine compels patients to contribute a higher level of involvement in their own care, and this can push them to be more regular are careful about meeting appointments and adhering to schedules. This increased involvement can also help lower the rates of obesity and use of tobacco, by motivating healthier lifestyles among patients.

Telemedicine is focused primarily on the benefit and convenience of the patient – e.g. the provision of appropriate and timely care. This is essential, in order to ensure that the care provided is high in quality. Using telemedicine, patients are able to obtain urgent consultations as and when they experience any health issue and gain information on options for treatment in no time.

A recent study reveals that patients who receive care via telemedicine display lower rates of stress, depression, and anxiety, in addition to having 38% fewer admissions in hospitals.

There are multiple treatment options for BPH, and when selecting a method, it is important for men to deliberate on the pros and cons of each. The option of prostate surgery has widely been considered the most effective method of treating BPH, but it is also the treatment option involving the greatest number of risks.

Treatment of BPH through medication is suitable for men who display major symptoms. Medicines for the treatment of BPH include alpha-blockers, which work to relax the prostate muscles and the bladder neck, consequently relaxing the urinary obstruction which occurs owing to an enlarged prostate in BPH.

Side effects of such medication include fatigue, headaches, lightheadedness, or difficulty with ejaculation. The most common types of alpha-blockers used for treating BPH include alfuzosin (Uroxatral), tamsulosin (Flomax), and medication that is older including silodosin (Rapaflo), terazosin (Hytrin), or doxazosin (Cardura).

The enlargement of the prostate in BPH is directly linked to DHT, so these medicines and help decrease the prostate size by 25% over 6-12 months. As a result, it takes this long to see betterment in urinary symptoms of BPH.

Transurethral resection of the prostate (TURP) is another procedure that has long been used for the treatment of BPH. Following the administration of anesthesia, a specialized instrument is inserted into the urethra via the penis. The instrument is then used to cut away parts of the inner prostate, thereby allowing for easier, unobstructed flow of urine from the bladder.

Laser treatment: There are many laser procedures available, and some of these can be administered in a doctor’s office with little to no anesthesia required. They focus on removing the tissue in the prostate that is causing obstructions. In these procedures, there is generally less bleeding involved and the recovery time is shorter than that for TURP.

Microwave therapy:
This type of therapy is usually delivered in the doctor’s office and is centered on using microwave energy to kill some cells in the prostate, which leads to its gradual shrinking.

Telemedicine has had profound implications on doctor-patient interactions and the provision of treatment and healthcare. However, despite its multiple benefits, the healthcare world has been slow in accepting and implementing telemedicine, and the entire process has been interspersed with complications. All this leads up to the big question – is telemedicine the healthcare of the future?

What are the implications for traditional healthcare organizations?
The hesitation to adopt telemedicine in clinics and hospitals is motivated, in part, by the apprehension that it might take the place of in-person contact and consultations between providers and patients. If patients can access their healthcare providers from the comfort of their homes, why would they bother coming to hospitals and clinics? However, this is nothing more than a misconception.

Instead of fearing the change, healthcare providers need to realize that telemedicine can be a great way to increase revenue. Setting up a system which allows patients remote access to doctors for virtual consultations will keep losses from skipped appointments to a minimum. Even if patients are unable to travel to the hospital/clinic for some reason or the other, they can still keep their appointment by arranging a virtual visit and then submitting payment for it online.

Therefore, the solutions provided by telehealth should be seen for what they are – effective growth opportunities for businesses, without incurring extra costs or utilizing excessive amounts of resources.

What are patients’ opinions on telehealth
Patients’ views on telehealth solutions are divided. Some patients are of the opinion that it is impossible to provide complete and thorough health care, diagnosis and treatment without an in-person visit and a physical examination. Patients who reside in rural or remote locations, however, feel that it is an effective and convenient solution, as it gives them the ability to consult specialists, which would be very difficult for them otherwise.

A global revenue forecast for telemedicine (2013-2018)
On a global scale, an increase has been detected in telehealth services and devices, suggesting that adoption of telehealth is on the rise. In light of this, the market is estimated to be worth $4.5 billion USD by 2018.

This growth and prediction suggest that despite the suspicions about telehealth and the quality of the care it provides, it is gradually gaining acceptance among providers and patients, as it increases convenience and ease of access to care, consequently leading to better healthcare results.

The growing pervasiveness of telemedicine software usage is also due, in part, to the increase in mobile phone usage, and changes in the behavior of patients, who are now connected 24/7 through smartphones and wearable gadgets such as smartwatches. In addition, the growing adoption of telemedicine can also be attributed to the ease it provides to chronically ill patients and those living in remote areas where they have little to no access to specialists.

The advantages and pros of Telemedicine are becoming increasingly hard to ignore, and these positive indications are not based on talk alone. Rather, they are backed by numbers – research and statistics indicate that Telemedicine shows huge potential for growth in the future, and added benefits for both providers and patients. Research shows Telemedicine is on a steady upward track and is likely to become more widespread and mainstream in the near future.

Globally, in 2014, the worth of the telemedicine market was pinned at $17.8 billion, and it is estimated to be far more than that by 2020. According to an estimate by ATA President Dr. Reed Tuckson, 2015 will see roughly 800,000 virtual consultations in the United States alone.

These promising signs are also echoed by healthcare systems, legislators, doctors, and patients – a current survey revealed that 90% healthcare executives were working on the creation/implementation of a telemedicine program. In addition, 84% of these executives believed in the importance of such a program.

Detractors of telemedicine claim its greatest drawback is lack of in-person visits, which they believe are not as effective as virtual visits. However, 76% of the patients in a survey claimed that being able to access a healthcare provider was more important to them than in-person visits with doctors.

In addition, just 16% of the patients said they would prefer going to the ER for a minor health issue if they were able to obtain treatment through telemedicine instead. Given the overwhelmed capacities of primary healthcare providers and the constant lack of open slots for patients, these numbers displaying patients’ openness to using telemedicine are a promising trend.

Owing to its relative newness, research on telemedicine and its impact is still in its nascent stages; however, various surveys have shown promising results. Following the implementation of telemedicine for patients with a history of heart attacks, the Veterans Health Administration found that hospital readmissions owing to heart failure were reduced by 51%.

Another research, conducted on the Geisinger Health Plan, found that telemedicine led to a 44% drop in 30-day readmissions to the hospital. Furthermore, on the patients’ end, a recent survey of 8,000 patients who received care through telemedicine found that they reported no difference between in-person care and virtual sessions, in terms of the results of their treatment.

Telemedicine is steadily cementing its position as an effective method for providing healthcare. A survey of healthcare executives revealed that the main motivation behind their implementation of telemedicine was the aim to enhance the quality of care being provided to patients.

Another research found that healthcare providers reported that the greatest advantage of telemedicine was being able to provide care 24/7. Close to half of the patients also responded that telemedicine compelled them to become more involved in their care and treatment.
Telemedicine is on an upward track toward a promising future.

By this point, you must be familiar with the concept of telemedicine. But what exactly is the procedure for the delivery of telemedicine systems? What are the technologies used to establish digital connections between doctors in metropolitan hospitals and patients living in distant, rural locations? Given the widespread proliferation of the internet, the methods for the delivery of telemedicine have undergone a change.

Now, all patients in rural areas need is a basic internet connection, and they can use it to avail at least some of the benefits of telemedicine. These are some of the types of connections that are used for telemedicine.

Networked Programs
The prime purpose of networked connections – such as high-speed internet lines – is to link small health centers in distant, rural locations with central hospitals in urban areas. As per the ATA, there are currently close to 200 networked programs for telemedicine in the United States, which provide over 3000 rural locations access to telemedicine.

Point-to-point Connections
Point-to-point connections use the high-speed internet to establish links between small clinics in remote locations and one large hospital. Telemedicine connections of this sort allow clinics that are small or dealing with a shortage of staff to outsource cases to medical care providers based in other facilities within the system. Point-to-point connections are used particularly for teleradiology, telepsychiatry, and cases requiring urgent care.

Monitoring Center Links
Monitoring center links are utilized exclusively for a single kind of telemedicine, i.e. remote patient monitoring. A digital connection is established between a patient’s home and a medical monitoring facility in a distant location. This connection allows for the measuring of patients’ medical data while they are at home, and the data is then electronically transferred to a medical facility in a distant location. Links of this sort are usually formed via internet, telephone, or SMS connections, and they are generally used for monitoring the data of cardiac, pulmonary, or fetal cases.

Integrating telemedicine with a healthcare practice can seem daunting and is a big decision to make. While there is no doubt telemedicine provides a wide range of solutions and advantages for providers and patients alike, it can be hard to reconcile it with a more practical outlook, and you might find yourself wondering whether telehealth can generate any revenue at all.

However, here are three ways in which telemedicine can help bring down your costs and boost revenue.

1) Reduction of costs at Dept. of VA
The Department of Veterans Affairs provides care to veterans and covers multiple, diverse areas – this means that traveling long distances for appointments often becomes inevitable for service members. To mitigate this problem early on, the Department of VA put a system in place which provides travel reimbursements for eligible patients. This cost can be greatly reduced through telemedicine.

2) Increased Healthcare Efficiency Leads to Greater Revenue
Telemedicine can lead to greater streamlining of the care provided by overcrowded departments of mental health. Mental health hospitals and clinics are usually deluged with a large number of patients’ requests for appointments, and overburdened capacities often mean that patients have to wait up to a year for their appointments. Owing to the extended wait period, most patients either forget their appointments or neglect their care completely – this results in additional costs for the institute, in terms of time, results, and overall efficiency. By offering the option of telehealth consultations to patients, providers have the chance to greatly increase their productivity. Providers can conduct faster and more efficient examinations of patients through customizable care offers, sessions conducted via video conferencing, and hours that are more flexible.

3) Mississippi Pilot Displayed Cost Savings in Diabetes Treatment
As per an article in the Health Data Management, a Mississippi telehealth pilot program reported savings with over $300,000 in the treatment of 100 patients of diabetes during six months. Not only did the results display lowered blood glucose levels and early diagnosis of eye disease linked to diabetes, but there were also reductions in travel expenses, and no instances of hospitalization or visits to the emergency room owing to diabetes.

The situations outlined above occur all over America, and you can also come across them on a global level.

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