Category Archives: Telemedicine

In the past few years, its been determined that patients are preferring telemedicine over the in-person doctors visits. As video conferencing continues to advance, its now easier to integrate with smartphones, tablets and other mobile devices. All that’s required is a reliable connection and HIPAA compliance to deliver the same healthcare as an in-office visit.

It’s been noted that in the last year alone, of the nearly 1 billion in-office visits, about half could have benefited from remote telemedicine according to the American Telemedicine Association. While telemedicine cannot replace a doctor’s visit, the average in-office visit is less than ten-minutes. Patients don’t seem to mind as a telemedicine visit can shorten their drive time and there are other factors that come into play:

Telemedicine visits offer convenience for physicians and patients

For people who live in remote regions, having a telemedicine service makes healthcare easier to manage. People in rural areas don’t have to travel as far and the video visits are convenient. There are patients in remote parts of Alaska who use telemedicine, as well as patients who offer from post traumatic stress disorder (PTSD) and rarely leave their homes. Telemedicine has also been received well by new moms at home with newborns and prison staff who may need to consult with a physician about a potential psych case.

It isn’t just the convenience of not having to travel far. Patients are reporting that they don’t have to take as much time off from work due to reduced waiting time to be seen. Patients prefer to not have to sit with sick people because it can exacerbate their symptoms. This is also reflected in the elderly, with children and chemotherapy patients

Attentive staff and better record keeping

Patients are reporting that they enjoy the telemedicine videos because they are finding more dedicated time with their doctors. Virtual visits still include getting vitals and answering questions which allows patients that one-on-one time to consult with a physician who isn’t rushed with a roomful of other patients waiting.

There’s a convenient record keeping aspect that is helping medical staff, as well. Physicians can take remote images of their patients, any unusual growths or injuries and then follow-up with them to compare the images. Because these records are stored remotely, the doctor has them readily accessible and can get all of the information without waiting on a medical records release or x-rays in the mail.

Its still shocking that this trend is continuing to be received so well given that its a video conference that patients are preferring. For patients its reassuring to know that they don’t have to wait for care and the doctor is right there – no matter where in the world he or she might be located.

The Affordable Care Act is a significant milestone in the US healthcare reforms process. Although the law was meant to enhance healthcare access particularly among the low-income earners and the middle class, its implementation has been facing myriad obstacles, and the idea of cheap insurance companies covering all medicals costs is becoming more elusive. According to Drew Altman, the president and the chief executive of the Kaiser Family Foundation, the nation has witnessed a major drift from what health insurance means for most Americans.

Altman notes that although the premiums have remained relatively stable, the deductibles for insurance that is sponsored by employers have gone through the roof as businesses struggle to cut cost. Employers are offering some incentives to keep their employees healthier, but the problem is that many of them are now limiting the choices of their employees when it comes to health care; they are offering narrow-network plans.

About 12.7 Americans are relying on individual health insurance from marketplaces established under the federal Affordable Care Act and another 7 million covered under the expansion of Medicaid and other provision of Obamacare. However, about 150 million Americans get their health insurance through their employers. That means that the largest part of the health insurance market in the US is outside the Affordable Care Act.

The 2016 employer health benefits survey conducted by Kaiser Family Foundation indicates that the premiums paid for employer-sponsored health insurance plans went up by 3.4% in 2016. The report further notes that the deductibles we up by 12%. Over the last five years, premiums rose by 20% while deductibles for single employees grew by 49%. This is worrying because it suggests that the medical costs are being passed to the employees, and these rates are much higher compared to inflation and wages.

According to Gary Claxton, the deputy president of Kaiser Family Foundation, the out-of-pocket medical costs are also on the rise. Gary further notes the increase in out-of-pocket medical expenses and the astronomically high deductibles among other forms of cost-sharing are only discouraging the consumption of medical services.

In conclusion, it is apparent that although the Affordable Care Act was meant to increase access to health insurance, that goal is far from being achieved. Premiums and deductibles keep going up, and the medical cost is being passed to the very people the law was meant to relieve. Besides, policies of the Obamacare are offering limited coverage and therefore, the out-of-pockets medical costs have gone through the roof.

It is no news that healthcare is getting ever more expensive. Baby boomers have turned to the internet for the solution. Baby boomers are people aged between 51 and 69. Over 60% of baby boomers are using cloud healthcare service Care Cloud to manage and upgrade their health records.

A higher percentage of baby boomers are utilizing these services that their younger counterparts, the Millennials and Generation X. they also have their older counterparts, senior citizens i.e. aged over 70 beat in this regard. They use the cloud-based service, to refill prescriptions and contact health care providers. Baby boomers are really taking advantage of digital healthcare tools.

It seems that they are more concerned about their health even using the services to ask doctors follow up questions. Reviewing your physician online has not taken off as well as the other uses of digital healthcare tools.

All of the places that people search to find a doctor, the website of their health insurer is the one they will probably use. It is a stark contrast to twenty years ago when referrals were the most common way for people to find a doctor. It is a testament to how much the internet has revolutionized the healthcare system.

Though very few, there are those that use social media platforms to find a doctor. Slightly more people utilize doctors’ websites to find other doctors such as specialists. A fair amount of people use search engines results or a review and rating website to find a physician.

The fact that health insurers are the go-to source for finding a doctor is no surprise due to the economic benefits of doing so. Online patient portals rule the modes of communication that patients prefer to use with their physicians.

Millennials will most likely change health care providers in order to use their online resources than any other age group. Online communication between doctors and their patients will continue to grow into the foreseeable future.

Mobile apps are extremely popular… there are so many different companies and sites that have mobile apps that make it extremely helpful for consumers/customers. The popularity of it has grow so much so that Pfizer Inc. has recently introduced a mobile app as well… the purpose of it is to be able to improve the monitoring and coping with depression.

Moodivator, which is what the name of the app will be, will have some great features, one of which is a mood tracker. This will be a simple scale that will allow patients to measure their emotional self-awareness throughout the day. It will also allow them to securely share their results with their family members and even professionals that work in the mental health field.

Patients will also be able to make goals for themselves as well as action plans that are relative to work, family, home and other social activities they may be involved in. This app has been designed to help balance the treatment that a patient will receive… it allows them to track their moods helping them keep a diary style of their mood, set goals the patient wants to meet and the patient will also be able to establish routines… this may help support the patient in their everyday life, according to Pfizer.

Dr. Susan Kornstein was consulted on designing the app; she is a psychiatry professor at Virginia Commonwealth University School of Medicine. Dr. Kornstein says the ability for patients to be able to track and export how they are feeling as well as see the progress they’ve made in the goals they’ve set in a way that is easy for them to read is extremely useful; and knowing this can be shared with doctors will help notify them of decisions when it comes to their care. This app will also help patients with some of their therapy techniques especially in the area of cognitive behavior.

The Moodivator is currently available to download in the Apple App store for free. For Android users, there hasn’t been a version developed as of yet.

Donald Trump, the president-elect of America, is expected to come up with various changes under his government. He appointed Tom Price, who has been an opponent of the Affordable Care Act, to head the department of health and human services. Price has come up with an approach that will change the Obamacare policy.

The changes will do away with the Obamacare strategy where the government runs people insurance based on their income to a strategy that will offer fixed tax credit according to people’s age rather than their income. In this case, people could choose to buy their insurance policies on their own in the private market. The young will get lower tax credits than the old which shall be done annually.

Under price’s approach, people will be allowed to save income after tax in the health savings account in order to pay for their future health expenses. This will apply even to those who already have a health insurance cover.

In order to help the aged and the sick get insured without challenges, Price has come up with a strategy to cut off the cost of enrollment but at a small percentage. This will be attained by providing grants to states to insure the elderly and people with serious illness although the amount set aside for the project is way too low having set 3billion dollars for a 3-year period.

Companies and employers exclude some tax in order to cover their employees’ health insurance. This amount will be reduced under Price’s approach since he will put a limit on the amount that should be excluded.

The health insurers will be permitted to sell their policies anywhere in all the States of America. Health insurance will hence be treated like any other insurance products which can be bought anywhere along the state line.

From the changes expected, Price’s approach will favor the financially able, young, and healthy people while oppressing the sick, elderly, and the poor. Although it eliminates the Obamacare policy where one had to include other benefit packages on the insurance policy which made it more expensive, insurers could charge the elderly enrollment fees higher than they should since there is no limit under the Price approach.

Athletics has been something that many have enjoyed doing for many years… as time goes athletes get bigger and better than they were before; but along with the person getting bigger and stronger concussions have become a larger issue as well, especially in athletes that are playing football. And while things in athletics have progressed, concussions have become an extremely troubling part of football on every level as well. Luckily there have been strides taken in certain states that will help in transforming the way things have been done in the past.

The Houston Texans in conjunction with GE have teamed up with the Houston Methodist Concussion Center and came up with a pilot that will be very beneficial for many. They have funded a telemedicine pilot that will run on trial for two years… it is focused on bringing specialized care for concussions. This care will be specifically for student athletes at 19 of the rural school districts that are found in Texas.

One of the portions of the pilot focuses on having an athletic trainer from Houston Methodist go out to the school or training facility, respectively, to give a comprehensive concussion evaluation whenever a student athlete has been injured during a game or even in practice and they have a suspected concussion.

Once this evaluation is done a physician from the Houston Methodist Concussion Center will give an examination through an HIPPAA-compliant video connection that is done online… they will be able to give a diagnosis as well as plan a treatment plan for the athlete.

Telemedicine is great especially in these situations… if you have an evaluation done as soon as possible when you think a concussion has happened then you can start treatments sooner… telemedicine saves you an office trip as well as time. In Texas, many student athletes find themselves two to three hours away from a concussion specialist; this program will allow the same level of care with concussions for everyone in the state in a viable amount of time.

If the Houston Texans, GE Healthcare and Houston Methodist Concussion Center find that this pilot is successful, the intend on expanding the program so all athletes that are in Texas will have access to telemedicine and the care experts for concussions. There has been an estimate of 3.8 million traumatic brain injuries every year, according to the Centers for Disease Control & Prevention… the majority of these injuries seem to go untreated… hopefully this number can be reduced with this program.

Majority Republican lawmakers under the leadership of president-elect have proposed an expansion of health savings accounts accessibility. The proposal makes it easier for one to pass HSAs to heirs, and a two-fold increase in contribution limits

As of June 30th, 18.2 million HSAs had been opened, a 25 percent increase from the previous year. Research shows there has been a 22 percent growth in assets to a $34.7 billion estimate by June. HSAs, which were introduced in 2003, offer you triple tax advantages.

The American Congress and the president-elect propose that HSAs should be part of the individual’s estate and could be transferred to heirs without the fear of death penalty. Currently, tax penalties are not taken for HSAs inherited from a spouse, but they are charged if The HSAs are inherited by someone who is not a spouse included in the heir’s income.

The changes Republicans have proposed include increasing the HSA contribution limits to maximum out-of-pocket limits for high deductible health plans. Therefore if and when those proposals become law each person’s limit would rise to $6,550 from $3,400 and the family limit would increase to $13,100 from $6,750.

House Republicans also propose to change the law so that spouses can be allowed to give catch-up contributions to the same HSA account; it also proposes to sanction qualified medical expenditure before HSA-qualified coverage starts to be refunded from the HSA provided that the account is opened within 60 days. Another proposal from Trump administration and Congress quarters is by repealing the so-called Cadillac tax: a critical factor of the Affordable Care Act, which levies a 40 percent excise tax on all the high-cost health plans. Last year, the start date of the tax was pushed back by a divided to 2020. The new proposal may see the employer Cadillac tax abolished immediately and therefore propel HSAs

HSAs are so popular because of the benefits employees get from them. Regardless of what President elects Trump or the Republican majority Congress does with HSAs, people will be taking n ardent interest in the progress to get the best out of it.

More than half the Americans have declared that they can only afford to spend $100 or less on medical insurance. The amount of money Americans are willing to spend on health insurance is way below the monthly cost of cheap health-care plans like Obamacare. The people claim that the premiums are too high and are opting for other individualized insurance plans that are within their budget.

The main problem is being experienced by those who need to buy medical insurance through Obamacare exchanges without subsidies. Americans are citing this difference for the second time in a row claiming they cannot pay more than $100 for medical insurance. The average premium cost for the most basic plan is above $300, and people are finding it more difficult to keep up with the rates. The difference in the rates and what people are willing to pay is enlarging the gap between privately purchased health insurance between the unsubsidized and the subsidized.

Americans who get a federal subsidy to buy insurance can fit the premiums for individual health insurance into their budget. The same applies for those who receive subsidized health-care through their employers. Individual health plans are affordable since they cost on average $94 per month. Those receiving a federal subsidy do not pay a lot from their pockets for the premiums. Premium costs are predicted to rise in 2017 for employer-sponsored plans to nearly $1500, and deductibles at small companies could go as high as $2000.

Americans are opting for individual health plans as they are more affordable. Most Americans have budgeted 4100 for their medical insurance, and the Obamacare premiums are not gaining popularity since they are way above the comfort level of the people. The difference in health-care premiums only tells part of the story when it comes to the affordability of health-care. If the premiums continue increasing, Americans will not have the ability to cater for their health care costs and people will drop out of the health insurance plan.

The Center for Medical and Medicaid Services (CMS) has received numerous calls from stakeholders to add telehealth service as Medicare-covered service. In response, it suggested an additional number of telehealth services eligible for Medicare reimbursement. Also, adjustment of Place of Service (POS) coding policies was proposed.

Eligibility for Reimbursement

For telehealth service to qualify for reimbursement, it must be:
• Listed as a defined set of service
• Rendered at an authorized location such as hospitals
• Administered by a licensed provider like physicians
• Provided using a particular telecommunication technology

CMS has acknowledged telehealth value through continuous additional of services that are eligible for reimbursement. In the Proposed Rule, CMS intends to add the following services to the list of those eligible for Medicare reimbursement:

• Consultations in critical care
• Advance care planning
• Services related to end-stage renal condition

Regarded but Declined

CMS received requests, which didn’t meet its set guidelines for reimbursable services. The following procedures were contemplated but they were declined:
• Emergency department services
• Observation services
• Physical therapy
• Speech-language pathology
• Psychological testing
• Occupational therapy

CMS referred to its cy2005 Physician Fee Schedule as its ground to reject psychological testing, emergency department, and observation services. It stated that occupational therapy, physical therapists, and speech-language pathologists are not approved telehealth practitioners. Therefore, those services offered by these specialists couldn’t be added to the list of reimbursement.

Policies of POS Code

POS codes are employed on professional applications to stipulate the site where services were provided. Currently, no POS code specifically for telehealth exists. However, with multiple requests to establish one, CMS has noted that the POS group controls the process and it isn’t dependent on Physician Fee Schedule decision-making. Meanwhile, CMS has suggested adjustments to the current POS policies, to act as guides for future rulemaking. For instance, telehealth providers report the POS code used when the service is rendered from a distant site.

In sum, CMS has shown through the Proposed Rule, its constant support and accommodation of the use of telehealth technologies as a way of rendering health care services.

Although the Affordable Care Act has helped the United States make significant strides insofar as reforming the health sector is concerned, the health sector still face some challenges that should be addressed. For instance, the law has seen the health insurers attenuate doctor network choices. As a result, the law has limited the access to healthcare services in rural areas and inner cities. Research shows that this challenge could be overcome by doing away with the regulations to give room for telehealth providers.

Telemedicine allows health care services consumers to have easier access to physicians via electronic gadgets such as phones and computers. This trend is becoming popular as consumers, employers, and private insurers seek to reduce the cost incurred through unnecessary trips to health centers. However, the narrow doctor network resulting from health insurance plans under the Affordable Care Act is leaving out patients in the inner cities and rural areas. Nonetheless, this is a weakness that telehealth providers network can exploit in persuading the regulators to accommodate them in the Obamacare-compliant network.

Robert Wood Johnson Foundation sponsored the Georgetown University research on network adequacy. According to the study, states limit access to telemedicine by insisting that patients have to meet doctors in person. Telemedicine also faces opposition from local medical practitioners who feels like they are being replaced systematically. In a statement accompanying the study, Kathy Hempstead of the foundation suggested that there could be ways for telehealth providers to prove that they offer adequate services to patients in the wake of stricter definitions of network adequacy in the states. According to Dr. Henry DePhillips, the chief medical officer at Telacod (a telehealth service provider), telemedicine should be valid for network adequacy rules under Obamacare.

Some health plans such as Aetna, Cigna, and United Health group are offering myriad benefits to employers including covering telehealth consultations. Unfortunately, they are not able to do the same when it comes to plans offered on the exchanges. In states like Ankara and California, patients have greater access to telehealth services. However, Professor Curtis Lowery of the University of Arkansas for Medical Services warns that having different network adequacy rules from state to state can create problems.

According to Hempstead of Robert Wood Johnson Foundation, it is imperative that telemedicine is recognized under the Affordable Care Act. He argues that the challenge relating to cost control has to do with making telemedicine a substitute rather than a complement to other more traditional health services. Hempstead believes that there are areas where telemedicine can help establish network adequacy and improve access, particularly to underserved communities.