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New legislation spells good news for patient care in Vermont. State Senate Bill S.50 expands insurance coverage for telemedicine services. This is especially helpful to patients who live in areas where specialists are rare or in short supply.

Currently, only telemedicine sessions that take place between two healthcare facilities are eligible for coverage. This act extends this coverage to encompass telemedicine sessions between a patient’s workplace or home and the providing healthcare facility.

Specific Provising in Vermont Senate Bill S.50

The new law directs the Vermont Department of Health Access (VHA) to ensure telemedicine services reimbursement for both the hosting facility and the treating medical provider. Exceptions apply if the clinicians at both ends of the session work for the same facility.

The bill also enacts the following provisions:

• Insurance payers must treat these services the same as they do in-person medical visits between their insurance beneficiary and a medical care provider.
• Insurers may require co-pays, deductibles, and coinsurance for telemedicine appointments, but they may not charge more for these services than they do for in-person medical visits.
• Store-and-forward technology provided teledermatology and teleophthalmology is reimbursible.
• Remote health care clinicians may be required to document the purposes for using store and forward options.
• Payers may request explanations for the use of telemedicine from the provider.
• Providers may not set maximums on telemedicine visits.
• Telemedicine use is expanded to a larger base of licensed, certified, or otherwise legally authorized health professionals.

In addition to expanding access to specialty medical care, the law also has potential benefits for mental health treatment. It allows patients in hospital emergency departments who are combating a mental health crises to connect with psychiatric services from the hospital. This real-time care may facilitate a quicker return home and decrease the need for psychiatric hospitalizations.

Vermont Governor Phil Scott signed the bill on June 7. The new law is set to take effect on October 1, 2017. This legislation applies to all health insurance companies proving coverage in Vermont, including Medicaid. Many see this as a positive step forward in expanding healthcare coverage and access without substantially raising costs.

Serving the southern counties of Maine and some parts of New Hampshire, York Hospital is consistently looking for innovative ways to improve patient care. The latest addition to the small hospital is a virtual care platform. In development since 2004, the telehealth platform gives patients an alternative option for accessing care. From the comfort of their home, via video and audio, a patient can speak directly to a doctor.

Using SnapMD, the hospital configured its telehealth platform to allow patients to make an appointment, register, and check-in for $49. Once a patient meets with a doctor, if in-person care is recommended, no fee is charged. Ideal for treating minor ailments, the platform is not meant to prevent a patient from accessing physical care if necessary. If a patient is bleeding uncontrollably, experiencing chest pain and shortness of breath, etc., the patient will be immediately told to contact emergency medical treatment.

Set up in an exam room, the virtual platform has already been used over a dozen times. Throughout these visits, several issues were encountered. Determining which web browser works the best, helping a patient with audio or video issues, etc. were all experienced. Glitches, bugs, and other issues were continuously worked through and the platform was repeatedly improved.

Containing a keyboard, two video screens, instruments, reference guides, and a York Hospital banner, the exam room harboring the telehealth system was designed to look as familiar as possible. Accessible to anyone with an electronic device, with video and audio capabilities, virtual doctor visits are by appointment only. Administrators are working on making the platform available to businesses, campgrounds, and hotels during the summer tourist season.

One of many hospitals throughout the country adding telehealth services to their roster, York Hospital now offers the additional care option to all area residents and visitors. The exciting new platform paves the way for increased efficiently and more effective patient care. York Hospital hopes this small step forward will lead to other technology-based initiatives. Further modernization of the hospital will enhance, widen, and improve both patient access and care.

When is the last time you felt bad or you hurt yourself, and just did not feel like heading to the doctor’s office or ER? Then you sit there for another one or two hours before you see the doctor.

On May 12, 2017, the Texas State Legislature passed SB 1107, this piece of legislature opens the door for telemedicine in the Lone Star State changing prior Texas law which allows physicians in Texas to use telemedicine to establish a valid physician-patient relationship without the need for an in-person exam.

WHAT IS TELEMEDICINE?

Telemedicine or Telehealth is the delivery of healthcare services and clinical information using the Internet, wireless, satellite and telephone media in Real-time live interaction between a health professional and patient or between physicians.

According to Evisit “More accessible, convenient healthcare for patients is the driving force behind the telemedicine field. Telemedicine was originally developed in the U.S. as a way to address care shortages, especially in remote rural areas”.

ADVANTAGES OF SB 1107

Texas is a big state with lots of outlying rural areas. Once, Governor Abbot signs SB 1107 into law; it will be a benefit to these areas, with easier access to healthcare. The disabled that have a hard time getting to the doctor will benefit. American Telemedicine Association tells us that it will create value for the payers, and providers and reduce the cost structure.

INSURANCE AND TELEMEDICINE

The National Law Review states that “Texas is among the majority of states to have enacted a telehealth commercial insurance coverage law. Texas’ coverage law prohibits a health plan from excluding a telemedicine service from coverage solely because the service is not provided through a face-to-face consultation”.

With the passing of the Texas State Legislature SB 1107, a precedence will be set opening the door for other states. Leave it to Texas to bring back the old practice of a house call with a new twist via the internet.

With US lawmakers attempting to repeal Obamacare, or the Affordable Healthcare Act, some women fear that their access to birth control may become limited. However, a new startup named Nurx (pronounced “NewRX”) is hoping to dash these fears away with their online birth control prescribing and shipping service. Essentially, Nurx is attempting to do to birth control what companies like 1-800 Contacts did for contacts.

Signing up and getting started on Nurx is incredibly simple. The user just downloads the free Nurx app and signs up for their free account. After the user has an account, the user just fills out a simple questionnaire that includes a few medical history questions, enters into a text-chat with a licensed doctor and is then prescribed their birth control. Not long afterward, the user is shipped a package that includes the user’s birth control method. Another really helpful aspect of Nurx’s system is that after the prescription is written, the user is then able to send messages to Nurx’s doctors if they have any medical questions. More importantly, for many people with insurance, this entire process is free, as Nurx does not include any delivery fees and does not charge for the initial consultation. This is a far cry from some of their birth control delivery competitors like PRJKT Ruby which charges $20 per month for their service

However, prospective users must keep in mind that Nurx is not able to deliver to every state. Currently, they are able to deliver to Washington, New York, Washington D.C., Illinois, Virginia, Pennsylvania and California. However, this is a feat as Nurx only employs 20 people and 5 doctors and was only established a year ago. Regardless of the Nurx’s age, it is gaining capital thanks to the fees that they charge the independent pharmacies that fill their prescriptions and a $5.2 million investment made by Union Square Ventures. With this said, if access to birth control tightens, businesses like Nurx are bound to encounter an increase in business.

Telehealth virtual visits are a hot topic and very high priority in hospital systems such as Kaiser Permanente. Many health systems are prioritizing telehealth as a technology option that can help the hospital contain costs while expanding their patient base.

Practitioners are realizing the old fee-for-service system isn’t working and continues to increase problems in a failing health care system. This type of health system was built around episodic care, in which people only entered into the system when hurt or sick. This also does very little to nothing to incorporate preventive care in regular patient visits.

As Bernard Tyson, Kaiser Permanente CEO, stated at a recent event, “We’re reimagining medical care.” These hospitals are aggressively investing technology to support telehealth for doctors and patients. Many of the hospital systems have used telehealth virtual visits as a way to make patient education and preventive care a top initiative rather than treating an illness when it occurs. Telehealth virtual visits, improve patient experience by offering convenient options for dealing with minor health issues.

Kaiser Permanente recently reported, 95% of its members are covered on a capitated basis, meaning that Kaiser Permanente is paid a monthly member fee to take care of a patient’s full range of healthcare needs. Members like the convenience of being able to get minor ailments looked at or get test results outside the doctor’s office.

Hospital systems can expand its patient base by offering telehealth virtual visits. Clinicians report these virtual visits allow them to see more patients for preventive care which ultimately reduce hospital cost. Telehealth virtual visits prove to be a big help for patients. In the old system, patients have to carve out a big part of their day for a visit, now they receive test results and follow-up visits in a fraction of the time.

Baby boomers are becoming seniors and retirees. Telemedicine providers plan to take full advantage of the need of these new seniors to stay independent and unencumbered. As telehealth and mHealth technology grows, remote patient monitoring options are becoming more robust.

Providers continue to develop innovations when it comes to providing care for seniors. This includes many developers taking advantage of mobile technology to add another element or dimension to telemedicine.

A good example of this comes from developers of mobile personal emergency response services, or mPERS. These applications would sit and wait for a problem to happen, and for someone to push a button. Software developers are actively working to improve these applications by making them full, real-time health monitoring devices and software.

One such developer, MobileHelp, intends to make their offerings more social in nature. The goal is to give baby boomers the ability to have a hub for all their wellness activities, not just an emergency device.

Large and small companies are pushing, or developing, telemedicine platforms and connectivity solutions. There’s various players in telemedicine, but they’re not all moving in the same direction. For example, GreatCall aims to bring health monitoring into every aspect of the home.

In this way, daily living will generate a constant data stream of habits and movements that tie into health. This type of passive monitoring can pick out trends and spikes. This can help seniors and their caregivers to fine-tune their diets, activities, and other aspects of daily living.

The main goal of all these innovations and plans is to make value-based care the norm. This type of care has a focus on the patient. It removes the fee-based method of always doing more to increase profits, as in more tests, more screenings, more doctor visits just to talk, etc.

Better, more focused care, can lead to fewer doctor visits and lower costs. For the more independent baby boomers, this approach, coupled with technology they’re familiar with, will create a new age of home-based care.

Telemedicine is a fast growing innovation in the health care industry. It is changing the way people seek and get medical advice, diagnoses, and prescriptions. Many patients are turning to telemedicine for timely, safe and efficient online health care services. It’s other benefits include:

Productivity
Unlike a doctor’s office or emergency room, with telemedicine, there is no waiting for an appointment in a room full of other sick people. Employees do not have to take time off work for time-consuming doctor’s appointments. You can simply schedule a doctor’s session during a break, or before or after work. Ability to stay healthy and engaged in health care through telemedicine enables employees to save time and give more at their workplaces.

Convenience
People don’t have to get frustrated waiting for slots to become available or arrange childcare to cover their appointments as they can access immediate appointments that suit them. With telemedicine, people can do away with routine stuff with just a phone call, e-mail or with video-conferencing from their office or comfort of their homes.

Affordability
Managing the rising cost of healthcare is a top priority for many. Telemedicine has helped to ease the situation by reducing expenses of caring for patients, transporting them to another location, or keeping them out of hospital stay. It is by far a cheaper option for supporting tight budgets as telemedicine users have the ability to get a single flat rate for each visit which gives patients predictability and transparency in cost.

Control
The beauty of telemedicine is that it gives patients a sense of control as one can access services regardless of where they are. With reliable and accessible services, telemedicine greatly decreases any additional mental or emotional strain that is experienced by patients when they cannot receive treatment at a time when they need to.

As health care continues to evolve and consumers become increasingly engaged in getting much of their medical information on-demand, telemedicine will continue to be an answer to patients’ needs.

Amazon has steadily crept towards the pharmaceutical market for a little while now. Evidence of its possible entry into the prescription delivery market can be seen in many of its smaller moves in that direction.

In Seattle, Amazon launched a local delivery service of non-prescription drugs under its Prime subscription service, through a well-known drug store. Earlier in the year, it Amazon added a pharmaceuticals category to its Japanese site. CNBC reported Amazon hiring key people to help it figure out how to enter into pharmaceutical market.

It’s no secret Amazon holds annual meetings where the viability of entering the pharmaceutical marketplace comes up. The company already has made inroads with auxiliary services, such as selling medical supplies and equipment.

Does Amazon have a chance in the pharmaceutical market?

Healthcare is in a state of flux, people want more options. Amazon has proven they can upset markets and firmly insert themselves into niches where most thought they would fail. However, the pharmaceutical market has some strong competitors who want to own prescription services.

Amazon would have to invest a substantial amount of money. They would have to offer discounts and incentives that can edge out the already robust field of mail-order prescriptions services. In addition, Amazon cannot deliver the type of personal care people typically want when it comes to picking up their prescriptions.

What Amazon has going for itself

Amazon is aggressive, and they have a logistics chain stretching across the country. Their distribution network is vast, and they have a proven history of figuring out ways to make goods cheaper and more available to those who want them.

Amazon is also not afraid to field-test and fine-tune new ideas. This all gives Amazon a few different paths into the pharmaceutical market. For example, they can purchase an already operating service and expand from there. Or, they can partner with small or large chain pharmacy companies that already have a delivery infrastructure in place.

It’s all speculation at this point, but one thing is for certain, Amazon is certainly looking into the possibilities.

For years, the United States has been experiencing an acute shortage of mental health professionals. Despite this shortage, the need for more accessible and effective mental health care continues to increase especially with the rise of opioid addiction epidemic particularly in the rural areas. Throughout the country, many of those who need mental health care have difficulties accessing it or choose not to seek help for fear of social stigma associated with mental illness. But according to a new report on telemental health, things are changing; there has been a significant growth in the use of telemedicine particularly among the Medicaid beneficiaries in the rural areas.

The report, however, indicates that this growth has been rather uneven across the population. The authors of the report led by Ateev Mehrotra, a professor of health policy at Harvard, noted that although there was rapid nationwide growth in mental health use among rural Medicaid beneficiaries, the use was not even in the population. For instance, between 2004 and 2014, the growth among beneficiaries with any mental health problem averaged at 45.1 per year while growth among beneficiaries with serious mental health conditions averaged at 49.3% per year.

The report also pointed to a signification variation from state to state. There were at least 25 visits per 100 beneficiaries in 9 states. The DC and four other states had no visits in the entire sample. The report did not cite the cause of the variation between states, but it did note that states with A-rating from the American Telemedicine Association with regards to the regulatory environment and those with telemedicine parity laws had higher rates of use.

The report also noted that there was significant variation in terms of the health professionals the mental health patients are visiting. 65.3% visited psychiatrists, 99.9% visited nurse practitioners, while 8.8 consulted clinical psychiatrists.

What is more interesting about the report is that it indicates that 87.3 of those who use telemental health also make in-person visits. This is worrying to those who have been arguing that telemedicine avails mental health service to those living in communities without such care. Indeed, only 12.7 use telemental healthcare exclusively. To this end, it is apparent that telemental health is complementing the in-person visit care.

In conclusion, the report recommends that any future payment policy for emerging health technology must insist on encouraging high-value care because in telemedicine, for instance, low-value care could be overshadowed by convenience.

Following an audit of Emory Healthcare’s telemedicine platform for its intensive care unit, Emory Healthcare saved around $4.6 million in Medicare expenses while simultaneously reducing post-discharge care and readmissions.

The results have followed a 15-month audit by Abt Associates of the eICU program deployed by Emory Healthcare based in Atlanta, Georgia. The program served more than 20,000 patients in this time frame in five hospitals.

“These independent findings verify that our innovative approach to addressing a highly variable, complex patient population – those in the critical care unit – improves patient outcomes, allowing them to leave the ICU healthier, thereby reducing the need for patients and their families to have extended rehab stays or be readmitted,” said Timothy Buchman, director of Emory Healthcare’s Critical Care Center, in a recent press release.

The Royal Philips telemedicine platform that Emory Healthcare uses provides critical care to 136 patients in five hospitals. In the audit, this system was compared to nine other Atlanta-area hospitals. Findings show:

• $1,486 reduction on average in Medicare costs over 60-day stay, adding to $4.6 million in 15 months;
• 4.9 percent less discharges to home healthcare;
• 6.9 percent less discharged to long-term care and skilled nursing facilities;
• 2.1 precent less readmission within 60 days.

In the press release, Manu Varna, business leader at Philips Wellcentive and Hospital to Home, says the findings conclude increased stability with reduced complications even after a patient discharged from ICU.

A similar eICU study at UMass showed 21 percent higher case volume and 376 percent higher contribution margins. Tele-ICU programs owe their success to an increased patient volume and higher quality care. The tele-ICU programs combined with a logistical center studied thus far indicate:

• 38 percent higher case volume
• 665 percent improved contribution margin

Emory Healthcare tried a new spin on eICU by partnering with Macquarie University in Sydney, Australia this past fall through spring, creating a network spanning two continents. This allowed clinicians to cover Emory’s eICU nighttime shifts while it was daytime in Australia and on weekends.

This helped test theories that quality of care drops during off hours when clinicians are not fully awake and thriving. The second theory is that off-hours shifts are typically covered by younger and less-experienced clinicians that lack seniority to avoid inconvenient hours. Studies have indicated that both these theories are valid.

Emory Healthcare should release results of this recent partnering soon.