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With physician shortage looming, hospitals turn to telehealth tools

Being able to connect with patients via video conference, and making diagnoses with high-res images, allows physicians to cast a wider net.

Jeff Lagasse, Associate Editor

Telehealth is beginning to mature as a viable arm of the healthcare industry, and it couldn't be happening at a better time. Thanks in part to an aging baby boomer population, many experts are predicting a physician shortage in the coming years -- one that can be addressed through telehealth technology, which allows doctors and specialists to be anywhere, anytime.

With telehealth gaining popularity among more and more groups of patients, including veterans, providers are sensing a revenue opportunity. They're also hopeful that being able to connect with people via video conference -- and making diagnoses with the help of high-res images -- can ease some of the workforce burden caused by too few physicians seeing too many patients.

"A lot of that is around the increasing population, and the increasing access people have to different modes of care," said Jeff Cutler, chief revenue officer of telehealth firm Tyto Care. "But more importantly it's the expectation people have that things be more accessible. Healthcare is somewhat antiquated when it comes to delivery, and having to come to an office. You have more efficiently connect people to the clinicians who are there."

According to Cutler, healthcare can learn to be more connected to its patient base by gleaning lessons from digital companies such as Uber and Lyft, which have supplanted taxis as the primary mode of ride-based transportation. Just as riders are connected to an Uber driver based on driver proximity and availability, telehealth can connect patients to the most available doctor, thereby circumventing any wait times that may result due to a shortage of physicians.

For that to work, telehealth has to facilitate an almost Uber-like user experience -- making sure everything is quick, smart, intuitive and functional. Apps that require the user to hold a phone camera against their mouth for throat imaging, for example, should work consistently, and also have a sense of fun and even gamification to it. Both the doctor and patient have to be engaged with the technology in order for it to be viable in stemming workforce pressures.

"Having healthcare be more of an on-demand delivery model helps with that," Cutler said. "It eliminated barriers including transportation, or even access for patients who are homebound."

Think seniors undergoing palliative care.

On the physician side, telehealth provides extra bandwidth in that it doesn't limit them to being in a certain place during certain hours. That's especially helpful for specialists. Oftentimes specialists who are employed by large, regional health systems split their time between two or more of the system's facilities, but given the right technological tools they can see anyone anywhere -- even if they live two hours away. It's convenient for both parties and cuts down on the transportation costs for each.

"Home healthcare can be supported with this type of model," Cutler said. "It's good for seniors that can't travel -- for whatever reason, transportation-wise people can't get out. And doctors making house calls is very expensive and impractical. With telehealth, nurse practitioners can make house calls and then connect back to the patient via the telehealth model. It's still a bit expensive to support in that typeof model, but the nurse practitioner can support lower-paid, lower-skilled medical professionals. Medical assistants, medical technicians can examine the patients, and they can probably address seven out of the 10 things they're seeing out there, but if they need to they can connect back to the nurse practitioner or the doctor if they're available."

The other benefit of telehealth in those scenarios is quality assurance. If there's a dearth of professionals who can examine a patient and a technician or assistant has to step in, their superiors can review the digital record of the examination to ensure that everything is tip-top. That allows clinicians to be spread more thinly without sacrificing quality.

Still, there are barriers to the implementation of telehealth, not the least of which is reimbursement. According to Cutler, general physician visits in the U.S. are reimbursed by payers at an average of $170 per visit, but the physician needs to be very thorough to submit for a larger reimbursement. In the industry, it's known as "going up the curve."

With telehealth, only level 1 reimbursements -- the lowest-paying category -- are supported by payers because there's doubt as to whether something like an ear infection can be effectively examined through a video connection. But that's starting to change as the technology evolves. By using remotely connected peripherals, it's now possible to examine organs and monitor for more advanced conditions, which in turn allows clinicians to submit for larger reimbursements.

Cutler envisions this technological shift accelerating, which will allow physicians to cast a wider net, and dampen the effects of the shortage as the aging population grows.

"When you have a cell phone, you make two decisions, the brand and the network," he said. "Telehealth will be like an unlocked phone -- you can connect to the backend. National providers will be available, but regional also, from larger health systems to the primary care physician. It benefits physicians because it allows them to open up their service areas and their markets in ways they could never have imagined before."

Twitter: @JELagasse
Email the writer: jeff.lagasse@himssmedia.com

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