Virtual visits to the doctor becoming more common
Expanded insurance, tech improvements help push telemedicine forward
Aided by his wife, Peter Schon wrapped a gray cuff around his upper forearm to take his blood pressure. Within seconds, thanks to wireless technology, his reading popped up on a computer screen in his home near where he sat in a brown leather recliner.
A couple of minutes later, the phone rang. On the other end was a registered nurse from a home care agency who had gotten a message that Schon's blood pressure was elevated. She wanted to make sure the Baltimore retiree was feeling OK and to determine whether she needed to intervene before his high blood pressure turned into a serious health problem.
Schon, 80, suffers from a variety of illnesses that keep him homebound, but telemedicine enables nurses to monitor him virtually. The technology-driven remote monitoring and treatment has him — as he put it — living in tomorrowland.
He could be right. In just a few years, telemedicine went from a promising but little-used form of health care, thought to be useful mostly in rural areas with few doctors, to one that is growing rapidly as technology improves, insurance coverage expands and pressure grows to keep people out of hospitals.
Last year, more than 15 million Americans received some kind of virtual medical care, according to the American Telemedicine Association. The trade group expects the number to jump by 30 percent this year. Nearly three-quarters of large companies will offer telemedicine doctor visits as part of their health packages this year, an increase from 48 percent last year.
In a nod to the large role telemedicine soon may play in health care, Johns Hopkins Medicine created the first administrative position and office dedicated to the practice this summer. Among the tasks of the new office is developing policies and guidelines around the use of telemedicine.
“I think the future market for telemedicine — the potential is incredible,” said Dr. Ingrid Zimmer-Galler, executive clinical director of JHM Telemedicine. “The market is exploding. Things you would think you can't possibly do from home are absolutely going to become a reality in coming years.”
Doctors and nurses across the state are using high-resolution cameras, smartphones and desktop computers to diagnose, treat and monitor patients.
They promote it as a way to better care for patients like Schon who can't easily get to the doctor and say it can help decrease emergency room visits. They also have found that many patients like not having to drive to the doctor's office.
State health officials see telemedicine as key to new reimbursement models that emphasize fewer hospital visits and more preventive care.
“Telehealth has the potential to increase access to care, improve patient outcomes and generate cost savings,” said Ben Steffen, executive director of the Maryland Health Care Commission. “Expanded access to telehealth will be an essential element of the new primary care models now being developed in Maryland.”
But some wrinkles still need to be worked out for it to become more widespread. Not all doctors and patients are ready to embrace remote treatment. And while private insurance and Medicaid cover telemedicine, doctors say the reimbursement process can be tedious and hard to prove.
“It is very challenging. You have to do it in a special way and meet certain criteria,” said Dr. Marc T. Zubrow, vice president of telemedicine at the University of Maryland Medical System. “The companies make you jump through so many hoops.”
CareFirst BlueCross BlueShield, the state's largest insurer, said it covers telemedicine if it is a face-to-face consultation and includes both video and voice services. In the last year, the insurer created Video Visit, where patients can see a doctor if their primary care physician is unavailable or they need treatment for common conditions or routine follow-up care. CareFirst also has given out $4.2 million to various providers to invest in telemedicine.
UMMS brought in Zubrow in 2012 to launch a telemedicine program for intensive-care units. Under the program, UMMS doctors can evaluate patients at 11 other regional hospitals via video camera as needed. The services have been helpful to smaller hospitals that don't have doctors on staff 24 hours a day.
“Whatever the nursing and medical staff can see, we have the computer capability to see at the same time,” Zubrow said. “It's as if we're at the bedside.”
UMMS has other telehealth initiatives and more in the works. For instance, physicians can evaluate patients who show up at smaller emergency rooms around the state to determine if they need to be flown to Baltimore for vascular surgery.
Johns Hopkins is using telemedicine in its own emergency rooms to examine patients with less urgent needs, so they won't tie up personnel involved in more urgent cases or have to wait long for care. Under the program, a remote doctor works with an on-site nurse to assess patients at specialized carts with a video monitor, stethoscope, otoscope and high-resolution camera.
In six months, the program has proved so successful in reducing wait times that Hopkins plans to expand it to other hospitals in its system, Zimmer-Galler said. It plans to bring telemedicine to other areas of the hospital in the next year, she added.
Physicians also are starting to use telemedicine in their offices. MedChi, the medical society that represents many of the state's doctors, held a session on the practice in October.
Dr. Michael Randolph, a Baltimore primary care physician, began incorporating telemedicine into his practice a few months ago and has seen 10 to 12 patients remotely. Randolph said it can be more convenient for his patients who may not have enough time for an office visit. He also said it is easy for him to squeeze in consultations between office visits.
But Randolph said doctors still have to worry about liability issues and for now he prefers to use telemedicine for patients with whom he already has relationships.
“Sometimes people are sick and you want to see them,” he said. “I tell them, ‘You look bad. You need to come in here.'?”
Schon, the retiree, started getting telemedicine services two months ago through a program run by Gilchrist Services. The health care company known for its hospice services runs a program for the elderly with either debilitating or terminal illnesses. They used a grant from the Maryland Health Care Commission and coordinate care with Lorien At Home, which employed the nurse who contacted Schon. The Gilchrist program has enrolled 15 patients, including Schon, since it started in August.
Ellicott City-based Lorien Health Systems also works with University of Maryland Upper Chesapeake Health to provide telemedicine services for patients at Lorien's three facilities in Harford County. Each of the skilled nursing facilities has a telemedicine room used to examine patients whose condition changes suddenly. Doctors for Upper Chesapeake examine the patient via video in hopes they don't have to come to the emergency room.
Tracie L. Schwoyer-Morgan, lead nurse practitioner for Gilchrist's palliative program, said the program's goal is to better monitor the health of patients
“The idea that we can physically see them without being there gives them some reassurance and comfort,” she said.
Schon's wife, Julie Schon, 72, said the service gives her peace of mind.
“I can go to the store and know if something happens, there is somebody monitoring him,” she said.