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HealthTap claims to bridge a big gap


Yet another health IT company wants to sell a system to streamline physician services.

HealthTap has a service in which patients send questions to a group of doctors about symptoms. Up to now, it has offered telemedicine, lab testing and other services, but now it’s branching out with what it calls an operating system, reports MedCity News.

The news site reports that HealthTap is trying “to solve the quandary that direct to consumer health services pose: balancing the demand for easy access to after hours treatment for short-term non emergency healthcare needs and improve continuity with patient’s electronic medical record.”

It sees its new HOPE  system as bridging  that gap. MedCity said “It includes things like patient responses to the most common health questions, and documents for doctors and patients to connect through video, voice, or texting, scheduling and billing services, e-prescribing and lab test order forms. It also sees a way to use its operating system to make it easier for practices to connect with patients through email and texting.”

Clinton pushes telemedicine reimbursement



A telemedicine center.

Hillary Clinton has come out  for widening Medicare reimbursement for telemedicine and for solving the interstate licensure issue that has held back telemedicine. That’s a huge issue for people in rural states, including Iowa, where Mrs. Clinton has been campaigning this week.


Residents accept the telemedicine age


Veteran physicians have been standoffish about using telemedicine to treat patients, be it by conference call, Skype or some other electron-rich device. But  most new physicians seem happy to use it, says a Medscape report that discussed residents’ attitudes on a range of topics, such as work-life balance.

In any event, medical economics and accelerating technological changes mean that physicians will have little choice but to increasingly use telemedicine. For one thing, the insurers will demand it to save money.








Cost concerns slow move to telemedicine

Donna Miles didn’t feel like getting dressed and driving to her physician’s office or to a retailer’s health clinic near her Cincinnati home.

For several days, she had thought she had thrush, a mouth infection that made her tongue sore and discolored with raised white spots. When Miles, 68, awoke on a wintry February morning and the pain had not subsided, she decided to see a doctor. So she turned on her computer and logged on to, a service offered by her Medicare Advantage plan, Anthem BlueCross BlueShield of Ohio. She spoke to a physician, who used her computer’s camera to peer into her mouth and who then sent a prescription to her pharmacy.

“This was so easy,” Miles said.

For Medicare patients, it’s also incredibly rare.

Nearly 20 years after such videoconferencing technology has been available for health services, fewer than 1 percent of Medicare beneficiaries use it. Anthem and a University of Pittsburgh Medical Center health plan in western Pennsylvania are the only two Medicare Advantage insurers offering the virtual visits, and the traditional Medicare program has tightly limited telemedicine payments to certain rural areas. And even there, the beneficiary must already be at a clinic, a rule that often defeats the goal of making care more convenient.

Congress has maintained such restrictions out of concern that the service might increase Medicare expenses. The Congressional Budget Office and other analysts have said giving seniors access to doctors online will encourage them to use more services, not replace costly visits to emergency rooms and urgent care centers.

In 2012, the latest year for which data are available, Medicare paid about $5 million for telemedicine services — barely a blip compared with the program’s total spending of $466 billion, according to a study in the journal Telemedicine.

“The very advantage of telehealth, its ability to make care convenient, is also potentially its Achilles’ heel,” Ateev Mehrotra, a Rand Corp. analyst, told a House Energy and Commerce subcommittee last year. “Telehealth may be ‘too convenient.’ ”

But the telemedicine industry says letting more beneficiaries get care online would reduce doctor visits and emergency care. Industry officials as well as the American Medical Association, the American Hospital Association and other health experts say it’s time for Congress to expand use of telemedicine in Medicare.

Popular Outside Medicare

“There is no question that telemedicine is going to be an increasingly important portal for doctors and other providers to stay connected with patients,” former Surgeon General Richard Carmona said in an interview.

Some health experts say it’s disappointing that most seniors can’t take advantage of the benefit that many of their children have.

“Medicare beneficiaries are paying a huge price” for not having this benefit, said Jay Wolfson, a professor of public health, medicine and pharmacy at the University of South Florida in Tampa. For example, he said, telemedicine could help seniors with follow-up appointments that might be missed because of transportation problems.

Aetna and UnitedHealthcare cover telemedicine services for members younger than 65, regardless of whether enrollees live in the city or in the country. About 37 percent of large employers said that they expect to offer their employees a telemedicine benefit this year, according to a survey last year by Towers Watson, an employee-benefits firm. About 800,000 online medical consultations will be done in 2015, according to the American Telemedicine Association, a trade group.

Medicare’s tight lid on telemedicine is showing signs of changing. In addition to Medicare Advantage plans, several Medicare accountable care organizations, or ACOs — groups of doctors and hospitals that coordinate patient care for at least 5,000 enrollees — have begun using the service. Medicare Advantage plans have the option to offer telemedicine without the tight restrictions in the traditional Medicare program because they are paid a fixed amount by the federal government to care for seniors. As a result, Medicare is not directly paying for the telemedicine services; instead, the services are paid for through plan revenue.

Republicans and Democrats in Congress are also considering broadening the use of telemedicine; some of them tried unsuccessfully to add such provisions to the recent law that revamped Medicare doctor payment rules and to the House bill that seeks to streamline drug approvals.

‘Changing This Dynamic’

This year, Medicare expanded telemedicine coverage for mental health services and annual wellness visits — when done in certain rural areas and when the patient is at a doctor’s office or health clinic.

“Medicare . . . is still laboring under a number of limitations that disincentivize telemedicine use,” said Jonathan Neufeld, clinical director of the Upper Midwest Telehealth Resource Center, an Indiana-based consortium of organizations involved in telemedicine. “But ACOs and other alternative payment methods have the possibility of changing this dynamic.”

AARP wants Congress to allow all Medicare beneficiaries to have coverage for telemedicine services, said Andrew Scholnick, a senior legislative representative for the lobbying group. “We would like to see a broader use of this service,” he said. He stressed that AARP prefers that Medicare patients use telemedicine in conjunction with seeing their regular doctor.

The American Medical Association has endorsed congressional efforts to change Medicare’s policy on telemedicine, as has the American Academy of Family Physicians. “We see the potential for it . . . to improve quality and lower costs,” said Robert Wergin, president of the academy and a family doctor in Milford, Neb. He said such technology can help patients who are disabled or don’t have easy transportation to the doctor’s office.

Anthem, which provides its telemedicine option to about 350,000 Medicare Advantage members in 12 states, expects the system to improve care and make it more affordable. “It’s also about the consumer experience and giving consumers convenience to be able to be face to face with a doctor in less than 10 minutes, 365 days a year,” said John Jesser, an Anthem vice president. Anthem provides the service at no extra charge to its Medicare Advantage members.

While seniors are more likely to have more complicated health issues, telemedicine for them is no riskier than for younger patients, said Mia Finkelston, a family physician in Leonardtown, Md., who works with American Well, a firm that provides the technology behind That’s because the online doctors know when they can handle health issues and know when to advise people to seek an in-person visit or head to the emergency room, she said.

“Our intent is not to replace their primary care physician, but to augment their care,” she said.

Telemedicine seen as undermining profession


Lee Schwamm, M.D., says that telemedicine vendors offering acute-care services risk undermining healthcare, just as charter schools have challenged public education and Fed Ex the U.S. Postal Service.

“Urgent care should be part of an integrated delivery network,” said Dr.  Schwamm, who is also the director of telestroke services at Massachusetts Massachusetts General Hospital, at the iHT2 Health IT summit in Boston.

MedCity News paraphrased that he said that “telemedicine companies risk creating their own information silos because they don’t do an adequate job of ensuring these patient-physician interactions get passed along to patients primary care physicians and aren’t designed with follow-up care in mind. They are also attracting dissatisfied physicians who want to set their own work hours rather than the long hours they currently work.”

“It destroys the profession,”  he said, adding, MedCity News reported, that it is attracting wealthier patients who can pay out of pocket for these services.

“It’s pulling dollars out of the healthcare system that are desperately needed to care for poorer patients.”





Telemedicine parity laws slowly spread

MedPage Today reports that 24 states and Washington, D.C.,  have enacted “parity laws requiring comparable coverage of and reimbursement for services delivered via telemedicine as is available for in-person services, by state-approved private insurance plans, state employee medical plans, and Medicaid.”

That’s up three states from last September.

“Health insurers in states still lacking parity laws are feeling the pressure, according to a major South Carolina healthcare provider….”

“Ninety percent of the private insurance [in South Carolina] is Blue Cross Blue Shield,”  pediatrician James McElligott,  M.D., medical director for telehealth at the Medical University of South Carolina (MUSC) Health, told MedPage Today. “‘They have each year taken baby steps [in telemedicine reimbursement]. [That’s] the main reason we are not going for parity legislation.”‘

“Telemedicine reimbursement is ‘not as good as we need, but we’re working with Blue Cross Blue Shield so that would cover the vast majority of the state,’ McElligott says. ”Insurers in states still lacking parity laws hope to avoid passage of such laws by responding to demands for greater coverage of telemedicine….”

“Medicare reimbursement of telemedicine services, the only category not covered by the ATA survey, remains a more daunting challenge to states with a particular kind of geography, such as South Carolina. In that state, ’44 out of 46 counties are rural by our definitions, but not by [Medicare’s],’ McElligott says. “It’s almost as if telehealth is only acceptable if you’re North Dakota, where you have these huge distances.”‘


In search of ‘frugal innovation’

Herewith a Becker’s Hospital Review look at how hospitals can engage in “frugal innovation”  that doesn’t require the vast sums of some technologically related innovation

“Frugal innovation — doing more with less — redefines the traditional notion of innovation in healthcare. It is often discussed in the context of emerging countries and economies, such as rural China and India, and may provoke images of makeshift tools and technologies. A lack of resources calls for the industry to find new ways to do things.”

Molly Coye, M.D., chief innovation officer of UCLA Health, says ”’frugal innovation’ sounds like it’s something entirely new and different. {But} frugal innovation begins with the patient experience and the problem to be solved. It asks the question, ‘How can we do this at the lowest possible cost and the greatest convenience for the patient and their family and still have high-quality results?,'” she told Becker’s.

As some observers have said, healthcare innovation shouldn’t be technology looking for a use, but rather a smarter use of technology. Consider, for example, telemedicine  to decrease clinic visits.


A push to make physician telementoring easier

The Houston Chronicle editorializes that overregulation of  medical training in some states  hurts efforts to train physicians in surgery and other specialties. In this case it refers to  telementoring, an educational initiative between doctors. not to be confused with telemedicine, the distance relationship between physician and patient.

The problem is that most states, including Texas, ”require a physician to obtain a medical license in that state before serving as a mentor.”The Chronicle asserts that this  regulation ”is overkill and makes no sense. Doctors and surgeons should be able to learn from and teach doctors around the country no matter where they are licensed. Texas could become a national leader in physician best practices by clarifying its licensing requirements to allow doctors and surgeons in all areas of practice to enter into mentor relationships with experts and learners out of state. ”

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