Federal Court denies TMB application to dismiss Teladoc case

December 22, 2015 | by

Readers may have read our article in April this year “Can State medical boards legally prevent telehealth activity?”. [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/12/US-district-court-1.jpg” thumb_width=”150″ /]In that article we examined the potential impact of a case brought by the Federal Trade Commission against the North Carolina State Board of Dental Examiners. The case went all the way to the Supreme Court which determined that the State Board of Dental Examiners was not protected by immunity from anti-trust law.

Teladoc is now locked in a case with the Texas Medical Board (TMB) that is very similar to the North Carolina case and it too has gone along a similar path so far. In the latest development of this case, last week a Federal Court, the US District Court in Texas, denied the application by the TMB to dismiss a case brought by Teladoc that claims that the TMB broke anti-trust law.

What has brought Teladoc and the TMB to court in this way? (more…)

47% of UK adults prefer virtual visits: Aviva Health Check study

December 19, 2015 | by | 1 Comment

Insurer Aviva’s latest Health Check study headlined the following findings about UK adults’ growing preference for digital health options, including a growth in acceptance of wearable monitors:

  • 47% are willing to be diagnosed digitally instead of face-to-face with their GP
  • 67% would use wearable technology to monitor long-term medical conditions such as diabetes or heart failure–especially those who are overweight (68%) or obese (71%)
  • The majority already using healthcare technology report improved health–63% of all age groups using a physical activity monitor say it has improved their health, rising to 66% of those with a heart rate monitor
  • Three in five (60%) non-users would use a physical activity or heart rate monitor in the future, while 52% would consider using a sleep pattern monitor
  • 55% agree the NHS should provide free technology to help people play an active role in improving their health
  • Younger age groups are most open (of course) to use of monitoring. 15% of those 25-34 use a physical activity monitor (compared to 8% overall) while 9% of 25-34s use a sleep pattern monitor (vs. 4% overall)

Aviva has an interest in digital health through its recently established customer partnership with babylon‘s UK-based telemedicine app [TTA 26 May]. The study was conducted by ICM Research for Aviva UK Health in August 2015. Respondents were invited from ICM’s online panel and 2,004 interviews were conducted amongst a nationally representative sample of the UK adult population.

The full study is available here to our Readers. Aviva release.

White paper identifies potential and challenges of telehealth

December 16, 2015 | by

Telehealth is a rapidly growing field that has the potential to help states leverage a shrinking and maldistributed provider workforce, increase access to services, improve population health and lower costs says a report published a few days ago. Called “Telehealth Policy Trends and Considerations”, the white paper from the National Conference of State Legislatures (NCSL) focuses on three areas: reimbursement of telehealth encounters, licensure for telehealth providers and patient privacy, safety and security.

This white paper is the result of a year’s work by a group brought together by the NCSL consisting of state legislators, legislative staff and private industry. The white paper provides options for state policymakers in these areas.

The paper also covers recent research into cost-effectiveness of telehealth, the impact of telecommunications connectivity and some specific examples of telehealth/telemedicine usage. Examples of effective use of telehealth includes the use of telehealth/telemedicine by the Veterans Health Administration. Another example cited is the telemedicine usage by the Unversity of Mississippi Center for Telehealth about which we have reported previously

The full 28-page report, is available to download here.

More Federal expansion of telehealth coverage proposed in Senate (US)

December 9, 2015 | by

The Telehealth Innovation and Improvement Act (Senate Bill 2343), a bipartisan bill to expand Medicare coverage of rural telehealth, was proposed last week by Senators Cory Gardner of Colorado and Gary Peters of Michigan. It would authorize Health and Human Services (HHS) to test new telehealth programs through the Center for Medicare and Medicaid Innovation. CMMI would then evaluate new telehealth models on cost, effectiveness and care improvement. Senator Gardner’s intent is to permanently expand rural telehealth. The bill has moved to the Finance committee. Another Senate bill may be proposed before the holiday break by Hawaii Senator Brian Schatz to integrate telemedicine technology into alternative payment programs including Medicaid Advantage, a service of great utility in his state where 70 percent of the population is on one island, Oahu,  and about 30 percent is scattered over four other islands. iHealthBeat, mHealthIntelligence.

Senate Veterans Affairs Committee takes evidence on VETS Act (US)

November 21, 2015 | by

Further to our report in October on the introduction of the Veterans E-Health & Telemedicine [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/10/Dept-of-VA-logo.jpg” thumb_width=”150″ /]Support Act (“Veterans eHealth & Telemedicine”, 10 October 2015), Sen. Joni Ernst’s website reports that Sen. Ernst was the first witness to testify in front of the Senate Veterans Affairs Committee on Wednesday (19 November 2015) about the proposed legislation.

“The VA has been practicing telemedicine since 2001, and they are largely cited as leaders and innovators in the field. Their efforts in telemedicine have saved money and veterans’ time by eliminating often an hour or more long drives to the VA, and reducing bed days at the VA” Ernst is reported to have said.

“For example: According to the VA, in Fiscal Year 2014, telehealth reduced bed days of care by 54%, reduced hospital admissions by 32%, and saved $34 in travel savings per  consultation. (more…)

Scientific survey of telehealth/telemedicine in the US

November 14, 2015 | by | 2 Comments

The Robert Graham Center for Policy Studies in Family Medicine and Primary Care sent [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/11/Robert-Graham-Center-logo.jpg” thumb_width=”150″ /]surveys to more than 5,000 randomly selected phyicians, intentionally oversampling rural ones, and received a high 31% response (1,557 respondents). Fifteen percent of the respondents indicated that they used telehealth  according to the report  on the analysis the data (the terms telehealth and telemedicine are used interchangeably in this report), “Family Physicians and Telehealth: Findings from a National Survey”, co-written by six authors, which is available now.

Compared with non-users, family physicians who use telehealth  are more likely to practice in a rural location, be younger, have practiced for 10 or fewer years, and employ an electronic health record (EHR), says the report. Almost half (49 percent) of telehealth users practice as part of an organization that is not physician owned (e.g., an integrated health or hospital system). More than half of telehealth users reported using telehealth one to five times in the past year, while more than 23 percent reported using telehealth on more than 20 occasions during the same period. Almost half of telehealth users stated they had used real-time video consultations in the past 12 months. In addition, 55 percent of surveyed telehealth users had used telehealth services for diagnosis or treatment in the past 12 months, and one-fourth of surveyed telehealth users reported using telehealth services for chronic disease management. (more…)

Drive to ACOs and value-based care may make 2016 The Year of Telehealth (US)

November 6, 2015 | by

An encouraging prediction? Two Foley & Lardner attorneys with evidently a great interest in healthcare predict that 2016 may very well be The Year of Telehealth. Why? They cite accountable care organizations (ACOs) and the coordinated care at the heart of their model as a protected activity under the Medicare fraud and abuse waivers. “Coordinating care, such as through the use of telehealth, remote patient monitoring, and other enabling technologies”is “an activity reasonably related to the purposes of the Medicare Shared Savings Program and therefore is eligible for protection under one or more of the fraud and abuse waivers”. National Law Review, mHealth News. While from the legal point of view this may be significant, there’s been a concatenation of other factors.

What are the drivers for telemedicine and telehealth in ACOs? In the Medicare Shared Savings Program (MSSP), which is one model, ACOs must leverage savings, and perhaps the largest is avoiding unnecessary hospitalization costs among ‘high-risk’ patients–those with chronic disease–and usually more than one. They are also over half of high ER/ED utilizers. The Federal agency behind Medicare, the Centers for Medicare and Medicaid Services (CMS) has since 2011 been signing up ACOs in risk and value-based payment models that offer incentives such as shared savings. In 2014, only 28 percent of ACOs in the MSSP program earned shared savings bonuses. (more…)

Dartmouth-Hitchcock withdraws from Pioneer ACO

October 23, 2015 | by

Dartmouth-Hitchcock Medical Center has announced it will withdraw [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/10/Dartmouth-Hitchcock-MC.jpg” thumb_width=”150″ /]from the Pioneer ACO program after losing more that $3M over the past two years.

The Pioneer Accountable Care Organization (ACO) Model was designed by the Center for Medicaid and Medicare Services (CMS) Innovation Center to encourage the development of ACOs which are groups of healthcare organizations and providers (e.g. doctors) that work together to provide care for their patients at a lower cost to Medicare while maintaining (more…)

Primary care ‘virtual health’ could save $10 billion annually: Accenture study

October 20, 2015 | by

A newly-released Accenture study on US primary care estimates that savings of about $10 billion per year in US primary care could be achieved through use of ‘virtual health’, defined as “digital tools such as biometric devices, analytic diagnostic engine and a virtual medical assistant” that would allow much of the work of a typical office visit to be done prior to or separately from the visit, and follow up/check in tools such as video visits/telemedicine which would further offset costs. The cost savings were calculated by Accenture Insight Driven Health as a total of time-per-visit savings of five minutes–when aggregated, $7 billion, $300 million in telemedicine visits, telehealth self-management in diabetes alone $2 billion, health system savings $63 million. This could potentially solve the shortage of US PCPs now projected at 31,000 in the next ten years. Nary a mention of patient care savings, chronic care management or telecare for proactive behavioral home monitoring, however. Accenture release (BusinessWire), Accenture page and paper.

Veterans eHealth & Telemedicine

October 10, 2015 | by

Currently in the US, the Department of Veteran Affairs may waive [grow_thumb image=”https://telecareaware.com/wp-content/uploads/2015/10/Dept-of-VA-logo.jpg” thumb_width=”150″ /]the state license requirements for telemedicine services if both the healthcare professional and the patient are located at facilities owned by the Federal Government, according to Sen Joni Ernst from Iowa (see Ernst pushes for expansion of telehealth care for veterans). She is introducing the Veterans E-Health & Telemedicine Support Act in the Senate which, if enacted, would permit VA to allow the use of any location, such as a patient’s home. This, it is argued, will give better access to elderly, disabled and rural veterans. Ernst says that with 21 million veterans nationwide and 12% of veterans receiving some form of telehealth care in 2014 this could reduce costs for the VA. It is. however, not clear how many of the veterans receiving telemedicine care necessarily need out-of-state healthcare professionals to provide that care.

A similar Act is being introduced (or rather, re-introduced) in the House of Representatives by Rep Charles Rangel, a Democrat from New York with 18 co-sponsors (see E-Health Legislative Summary: The Veterans E-Health & Telemedicine Support Act of 2015). That act has previously been introduced in the House in 2012 and 2013 according Govtrack and its chances of being enacted this time round are considered very low (1%).

Connected health to help cure–physician burnout?

October 6, 2015 | by

Here’s an interesting proposition: digital health tools such as telemedicine, telehealth and mobile health can help to reduce physician burnout. Except that if one is looking for support points in this HCI Healthcare Informatics article, one would be hard pressed. There’s no link to QuantiaMD‘s study (a 225,000-member US physician community), an inexplicable lapse. Your persistent Editor tracked it down, and found it connects the dots a bit more. It starts with the proposition that nearly half of doctors wouldn’t recommend medicine as a career to their children, then identifies a key frustration–“healthcare technologies that sap time and money are among the top reasons.” The solution? Other “emerging technologies—in the form of telemedicine, mHealth tools, and connected health devices—may actually help reverse this trend of physician burnout.” The paper then describes how telemedicine virtual visits, giving patients telehealth tools which will aid compliance and monitoring, especially with new treatments, and the opportunity to improve care all are Good Things. But not entirely convincing that these can be effective in mitigating the complex reasons why behind doctor burnout. Read the QuantiaMD study for yourself. Hat tip to Stuart Hochron, MD, JD of Practice Unite via LinkedIn

Does telemedicine video quality influence clinical acceptance?

September 24, 2015 | by

A pointer for connected health designers. An Australian study reviewing telemedicine virtual consults examined the technical factors that may influence clinical acceptance. It compared the quality of cellular (3G) connectivity with broadband fiber-based service during virtual visits. While overall clinicians rated the telemedicine visits highly–equivalent to or better than a home visit 76 percent of the time and conducting a video consult compared with a home visit as equivalent or better 90.3 percent of the time–the lower audio/video quality of the visits over a 3G data connection versus broadband was apparent, enough that ‘statistically significant associations were found between audio/video quality and patient comfort with the technology as well as the clinician ratings for effectiveness.’ The high failure rate of 3G was also dramatic–23.5 percent of visits calls dropped.

The study was conducted at south Australia’s Flinders Telehealth in the Home (more…)

ONC gets in study game in designing the Consumer Centered Telehealth Experience

September 23, 2015 | by

ONC (the Office of National Coordinator for Health Information Technology, HHS) in the spring conducted a design session on creating a more consumer-centered telehealth experience, commissioning the engagedIN research firm to help select a panel, run it and produce the study. The white paper focuses on how telehealth can either further fracture or integrate PHR (study pages 7-11), and what’s needed to make telehealth and telemedicine more convenient and effective for consumers. The panel avoided the big telemedicine providers (a bone that Mobihealthnews picks with the study) which typically dominate these panels–to this Editor a positive action–but included other telehealth providers like Qualcomm Life, Care Innovations and Zipnosis, as well as the US’ largest user of telehealth, VA Home Telehealth. Among the key drivers of telehealth are HHS’ and private insurers (UHC) shift to value-based payments; CMS’ target of 50 percent of Medicare value-based care is cited (page 5). There are nine principles at the end (pgs 13-16) to guide the way forward. Designing the Consumer Centered Telehealth and e-Visit Experience (PDF) (Though it is confusing why e-Visit was used rather than ‘virtual visits’ or, in fact, telemedicine.)

CVS puts a retail triple spin on telemedicine

September 1, 2015 | by

A definite boost to telemedicine providers American Well, now-publicly traded Teladoc and Doctor on Demand is retail drugstore CVS Health piloting their services through CVS MinuteClinics, starting in 2016. CVS’ release is disappointingly heavy on company quotations, light on specifics, but what can be determined is that CVS will test various arrangements, including onsite telemedicine in stores, through CVS ‘digital properties’ (presumably online or through apps) and MinuteClinic provider consults with telemedicine provider doctors. It carefully avoids referring to the three companies as ‘partnerships’ though it generically refers to them deep in the release. CVS currently has 1,000 MinuteClinic locations in 32 states and plan to grow by 50 percent by 2017; they have been testing telemedicine in about 50 clinics in Texas and California.

Annoyingly, both CVS and the three companies improperly use ‘telehealth’ in describing their services when correctly they provide only doctor-patient video consults, or telemedicine. The clinic providers (or individuals) may be reporting vital signs data as part of the visit, but tools are not integrated. Equally annoying is CVS, in the release and in conferences, citing a paywalled study (at the not inconsiderable sum of $39.95 / €34.95 / £29.95!) in the Journal of General Internal Medicine (JGIM) of their results. If you are touting that “95 percent of patients were highly satisfied with the quality of care they received, the ease with which telehealth technology was integrated into the visit, and the timeliness and convenience of their care.” –well, with results like that, make some arrangements and grant access to the study! CVS release, Medscape, FierceHealthIT

Telemedicine, telehealth underutilized in pediatric care

August 28, 2015 | by

In focusing on older adults on Medicare and secondarily the disabled, the use of telemedicine and telehealth is being overlooked for chronically ill children, especially those living at distance from specialized care. Children’s hospitals Many of these seriously ill children are either covered by parents’ employer plans or, if the family is low income, state Medicaid programs. This interview with Andrey Ostrovsky, MD, an attending physician at Children’s National Medical Center in Washington DC, notes the lack of incentive for innovative care which could utilize healthcare technology profitably. There is also a Medicaid waiver approval for telehealth reimbursement used for older person care, called the 1915(c) waiver for home-based and community services, which can be used for children. FierceHealthIT

ATA Fall Forum updates

August 7, 2015 | by

If you are thinking about attending ATA’s Fall Forum sessions in Washington, DC this September, the early bird discount of $100 has a week to go–14 August is the last day. This year’s meeting also has, in addition to the conference, a National Telehealth Lobby Day (16 Sept) with short briefings on how to lobby, the key issues and a half-day to make those previously scheduled visits to your Senator or Representative. The updated schedule for the three-day conference is here.

Also for ATA 2016 in Minneapolis next 14-17 May, the call for presentations has just opened. See details here.

TTA is a media partner of ATA Fall Forum, and previously ATA 2014 and 2015.