To Your Health With Dr. Jim Morrow: Episode 31, Telemedicine and Georgia Opens Up

To Your Health With Dr. Jim Morrow: Episode 31:  Telemedicine and Georgia Opens Up

Dr. Morrow offers his thoughts on Gov. Brian Kemp’s “opening” of Georgia, as well as a thorough discussion of telemedicine, its pros and cons, and how he is using telemedicine currently to treat patients at Morrow Family Medicine.  As always, Dr. Morrow responds to listener emails and feedback, including one from a disgruntled tinnitus sufferer. “To Your Health” is brought to you by Morrow Family Medicine, which brings the CARE back to healthcare.

Morrow Family Medicine is an award-winning, state-of-the-art family practice with offices in Cumming and Milton, Georgia. The practice combines healthcare information technology with old-fashioned care to provide the type of care that many are in search of today. Two physicians, three physician assistants and two nurse practitioners are supported by a knowledgeable and friendly staff to make your visit to Morrow Family Medicine one that will remind you of the way healthcare should be.  At Morrow Family Medicine, we like to say we are “bringing the care back to healthcare!”  Morrow Family Medicine has been named the “Best of Forsyth” in Family Medicine in all five years of the award, is a three-time consecutive winner of the “Best of North Atlanta” by readers of Appen Media, and the 2019 winner of “Best of Life” in North Fulton County.

Dr. Jim Morrow, Morrow Family Medicine, and Host of “To Your Health With Dr. Jim Morrow”

Dr. Jim Morrow is the founder and CEO of Morrow Family Medicine. He has been a trailblazer and evangelist in the area of healthcare information technology, was named Physician IT Leader of the Year by HIMSS, a HIMSS Davies Award Winner, the Cumming-Forsyth Chamber of Commerce Steve Bloom Award Winner as Entrepreneur of the Year and he received a Phoenix Award as Community Leader of the Year from the Metro Atlanta Chamber of Commerce.  He is married to Peggie Morrow and together they founded the Forsyth BYOT Benefit, a charity in Forsyth County to support students in need of technology and devices. They have two Goldendoodles, a gaggle of grandchildren and enjoy life on and around Lake Lanier.

Facebook: https://www.facebook.com/MorrowFamMed/

LinkedIn: https://www.linkedin.com/company/7788088/admin/

Twitter: https://twitter.com/toyourhealthMD

The complete show archive of “To Your Health with Dr. Jim Morrow” addresses a wide range of health and wellness topics, and can be found at www.toyourhealthradio.com.

 

Dr. Morrow’s Show Notes

Coronavirus Update

 

Worldwide cases: 2,561,915

Total Deaths: 177,200

Total Recovered: 679,819

Total Hospitalized in the US: 120,268

Hospitalized in Georgia: 3,779

Incidence rate: 198.89 per 100,000 persons

Antibody test not yet generally available and the tests have a cross reactivity with some of the common cold CVs.

The average number of people who become infected by an infectious person is declining in every state. See this at rt.live.

 

Telemedicine Facts

• According to Healthcare Business & Technology,
  • Almost 75% of all doctor, urgent care, and ER visits “are either unnecessary or could be handled safely and effectively over the phone or video,”
• MedCity Newsreports that 90% of healthcare executives say their organizations are developing or already have a telehealth application.
• The majority of healthcare organizations are increasing or maintaining their telehealth investments this year.
• According to the American Hospital Association, about 20% of Americans live in rural areas without easy access to primary care or specialist medical services.
• A survey conducted by American Well found that 65% of consumers want to use telehealth
• According to the American Hospital Association, more than three-fourths of hospitals are currently using or implementing telehealth.

Pre-Pandemic Situation

 Limited Medicare coverage impeded the expansion of telehealth services.

• • Current statute restricts most telehealth services to patients located in
    • rural areas and
    • in specific settings (such as a hospital or physician office),
    • covers only a limited number of services, and
    • allows only real-time, two-way video conference capabilities.

• Changes needed include:
  • widespread elimination of geographic and setting locations requirements so patients outside of rural areas can benefit from telehealth;
  • expanding the types of technology that can be used, including remote monitoring; and
  • covering all services that are safe to provide, rather than a small list of approved services.
• Additional research is needed to evaluate telehealth.
  • Research and experience under the Medicare program suggest that policymakers’ concerns about increased access to telehealth leading to increased spending may be overstated,
    • particularly when weighed against the potential benefits in quality, patient experience and efficiency.
    • However, there are insufficient studies on the cost-benefits of telehealth outside of a limited number of services.
  • Federal programs to expand broadband need to be simplified.
    • According to the FCC, 34 million Americans still lack access to adequate broadband.
    • And, there is a large digital divide, with almost 40 percent of those living in rural areas lacking access.
      • The FCC has a program that supports broadband adoption, but it is administratively burdensome and provides an insufficient level of subsidy for remote health care providers.
        • While the FCC has taken positive steps by increasing the subsidy, we need even greater federal investment in broadband access, particularly in rural areas.
      • More and better research is needed for other conditions and newer technologies, such as remote monitoring of patients.
    • Telehealth connects patients to vital health care services through
      • videoconferencing,
      • remote monitoring,
      • electronic consults
      • and wireless communications.
      • By increasing access to physicians and specialists,
        • telehealth helps ensure patients receive
          • the right care,
          • at the right place,
          • at the right time.
        • Currently, 76 percent of U.S. hospitals connect with patients and consulting practitioners at a distance through the use of video and other technology.
          • Almost every state Medicaid program has some form of coverage for telehealth services,
            • and private payers are embracing coverage for many telehealth services.
            • However, there are barriers to wide adoption of telehealth.
            • Medicare generally still limits coverage and payment for many telehealth services, lagging behind other payers.
            • The Medicare program recently expanded coverage for telehealth services for stroke patients and substance use treatment in response to statutory changes.
            • Medicare also expanded payments to clinicians for virtual check-ins.
              • While promising,
                • these incremental steps are not sufficient.
              • In addition, limited access to adequate broadband services hampers the ability of some rural facilities to deploy telehealth.
              • The challenge of cross-state licensure also looms as a major issue.
              • Other policy and operational issues include credentialing and privileging,
                • online prescribing,
                • privacy and security
                • and fraud and abuse.
              • The federal government needs to do more to increase the use of telehealth.

Telemedicine and Covid-19

• Healthcare is seeing a surge of direct-to-consumer telemedicine providers
  • operating at a large scale
  • helping to provide care to patients who might be wondering if they need care after exhibiting potential symptoms associated with the novel coronavirus.
• Simultaneously we’re also seeing a rapidly increasing need for on-demand acute care via telemedicine.
  • This includes ICU programs offering intensive care for the most critical patients.
    • However, tele-triage is exploding in terms of the number of use-cases that involves determining when a patient presents in the emergency department whether they need to be issued a bed or if they can be seen in another area within the hospital in order to keep the patient safe and to reduce potential exposures.
  • This helps to limit providers’ exposure to the virus and other infectious diseases.
• If a hospital worker is exposed without adequate protection, they’d be put into self-quarantine for 14 days
  • Using acute telemedicine for tele-triage is helping keep staff in a low-risk category for infection
    • by completely eliminating exposure for those doctors or other hospital staff.
• Unfortunately, providers and policymakers are playing catch-up with telehealth technologies right now
  • and are just beginning to recognize that they are essential solutions for keeping potentially infected individuals out of hospitals and doctors’ offices
  • As this public health crisis continues to escalate, however,
    • telemedicine is quickly gaining recognition as a critical tool to slow the spread of COVID-19
  • There are three primary roles for telehealth technologies during this crisis
    • The first:
      • to screen patients remotely rather than having them visit the practice or hospital.
      • They can be used to triage patients with cold and flu-like symptoms and to remotely care for those who don’t need medical intervention or could receive care at home.
      • By keeping potentially infected individuals out of hospitals and doctors’ offices, the healthcare system can lower the risk of transmission to other patients and healthcare staff.
    • Second:
      • To help provide routine care for patients with chronic diseases who are at high risk if exposed to the virus
    • And third:
      • Providers and their staff are not immune to infection and are at increased risk for contracting COVID-19 due to their continuous exposure to infected patients
        • Once tested and confirmed, these providers will be quarantined and become unavailable to the healthcare system just when it needs them most.

Limitations of Telehealth

• Inability for most clinicians to fully examine a patient
  • The hardware exists to do this but it is expensive and has limitations
• Limitations in broadband and device access
• Laboratory testing not possible
• In cases where patients are using on-demand telemedicine services that connect them with a random healthcare provider, care continuity suffers.
• A patient’s primary care provider may not have access to records from those other visits and end up with an incomplete history for the patient.
  • Service provider shuffling increases the risk that a doctor won’t know a patient’s history or have notes about care routines.
• Healthcare laws, reimbursement policies, and privacy protection rules struggle to keep up with this fast-growing industry.
  • As a healthcare provider, you want to promote best practices when approaching telemedicine.
• While major developments have been made to telehealth reimbursement over the past couple years, it still remains a common stumbling block for providers interested in telemedicine.

The Bottom Line

• Telehealth helps increase health care value and affordability.
  • Virtual care technology saves patients time and money,
    • reduces patient transfers,
    • emergency department and urgent care center visits,
    • and delivers savings to payers.
  • In addition, telehealth helps address physician burnout by reducing clinicians’ drive times and allowing more time for patients.