April 25, 2018
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Telemedicine offers doctor’s house calls

By Meg Haskell, BDN Staff

ORONO, Maine — The next time you need speech therapy, mental health counseling, a blood-pressure check or intensive hospital care, the treatment you receive may well be provided by way of the Internet.

Telemedicine, a fast-growing health care trend in rural areas, is playing an expanded role in Maine hospitals, clinics and home care agencies.

About 140 health care providers, administrators, policymakers and others from around the state gathered Tuesday at the University of Maine for the first Maine Telemedicine Summit to learn more about the ways in which the technology is already in use and its potential for improving care and holding down costs in the health care system.

Built on the now-familiar technology that makes business videoconferencing and distance education possible, telemedicine uses high-definition computer imaging and audio capabilities to allow patients to be examined, diagnosed and treated by clinicians who may be many miles away.

“We are in an amazing time in America for the transformation of our health care system,” said Dr. Dale Alverson, president of the American Telemedicine Association and the keynote speaker at Tuesday’s conference.

Health information technology — including telemedicine, electronic medical records, research databases and other computer-based elements — will be essential components of that transformation, he said, especially in rural areas.

But expanding the use of telemedicine faces a number of challenges — including the fact that many public and private insurance plans won’t pay for it, Alverson said.

Maine is a leader in using telemedicine, and also has overcome a significant reimbursement hurdle. Still, proponents say it is important to incorporate telemedicine services into more settings and to require insurers to pay for those services routinely.

One of the first grant-funded telemedicine projects in the nation was established in 2001 in Washington County and remains in limited use today. Since then, the technology has been adapted for use in many settings in Maine, several of which were highlighted at the conference.

Trauma surgeon Rafael Grossman of Eastern Maine Medical Center in Bangor described the hospital’s “teletrauma” program that provides support to clinicians in rural hospitals. The program allows specialists at EMMC to consult with colleagues at smaller hospitals on emergency cases, helping decide how best to stabilize critically ill or injured patients and determining whether those patients can be safely treated at the smaller facility or must be taken to larger hospitals in Bangor, Portland or Boston.

The program has been in place for several years, he said, and is credited with saving lives, averting unnecessary transport and treatment, and making life easier for patients and their families.

In home health settings, compact telemedicine units connected to computer lines allow homebound patients to measure and enter their own vital signs each day — blood pressure, pulse, respiratory rate — along with other data such as weight and blood oxygen levels. An on-screen visit with a nurse, mental health counselor or other provider helps determine a home-bound patient’s mood or mental status and allows the provider to examine wounds or perform other physical assessments.

Nurse Carol Carew of Eastern Maine Home Care said using these units has significantly improved the management of chronic illnesses such as diabetes and lung disease and has reduced emergency department visits and rehospitalization, especially among older Mainers.

Her agency owns 46 tabletop telehealth units and expects to purchase an additional 24 in the near future. Each unit costs between $1,500 and $2,400.

Telemedicine also plays a role in hospital intensive care units, providing around-the-clock clinical backup to staff in large and small ICUs. Nurse Sue Goran of MaineHealth in Portland said the Maine Medical Center’s “EICU” — electronic intensive care unit — supports 13 ICUs in nine southern Maine hospitals.

Especially in rural areas where qualified doctors and nurses are hard to recruit, she said, telemedicine plays a valuable role in monitoring the very sickest patients.

At Waldo County General Hospital in Belfast, speech pathologist Michael Towey uses sensitive telemedicine equipment to treat adults and children suffering from speech and swallowing disorders in their homes. The service provides greater convenience for families and caregivers, he said, and in some cases produces better results in a shorter time.

Towey even recently treated a young man in Taiwan who suffered from spasms in his voice box.

“Six treatment visits and we fixed his problem,” Towey said.

Keynote speaker Alverson said there is no doubt that the use of telemedicine in such settings can increase access to essential health care services, improve patient health and hold down costs. Yet, virtually all telemedicine projects nationwide are funded primarily through public and private grants, an unstable and unsustainable financial model.

Private insurance companies have been slow to endorse the technology, he said, and the publicly funded Medicare and Medicaid programs also are proceeding with caution.

A professor of pediatrics at the University of New Mexico School of Medicine and the director of the university’s Center for Telehealth and Cybermedicine Research, Alverson described a project in New Mexico that provides neonatal ultrasound exams to rural women in high-risk pregnancies, allowing specialists in big-city medical centers to see and hear the diagnostic examination in progress. The project has effectively identified mothers-to-be who need to be admitted to inpatient care while keeping others safely in their home communities.

“The worst thing you can do is put a high-risk mother on the road,” Alverson said.

Another New Mexico project provided a one-day free eye clinic in suburban community for people with diabetes. Eye specialists in another city used live computer technology to examine patients for damage to their retinas, a common complication of poorly managed diabetes and a precursor to blindness. Nearly half of the patients screened at the public clinic showed signs of early retinal damage and were referred for treatment, he said, and blindness was averted in several cases. Ironically, he said, Medicare will not pay for the preventive telemedicine examinations, but routinely covers the much more expensive cost of treating advanced damage and loss of sight.

In Maine, a new provision in state insurance law took effect last September, requiring all private insurance companies doing business here to pay for services delivered by telemedicine the same way they pay for a face-to-face encounter. The measure was sponsored by Rep. Anne Perry, D-Calais, a family nurse practitioner who co-chairs the Health and Human Services Committee.

Alverson called the Maine initiative “remarkable” and said no other state has adopted such a far-reaching measure.

So far, said Katie Dunton of the Maine Bureau of Insurance, there is no evidence that insurers are not complying with the statute and there have been no complaints filed with the bureau’s consumer division.

MaineCare, the state- and federally funded Medicaid program for low-income and disabled residents, pays for some telemedicine services but requires extensive documentation and prior authorization. The most common use of telemedicine in MaineCare is in mental health counseling.

The federal Medicare program for the elderly pays for some telemedicine services but has demanded data to show that the quality of care provided by telemedicine is as high as in face-to-face encounters. Those data are being compiled now, Alverson said, and he is hopeful that the Obama administration will adopt more generous reimbursement guidelines for Medicare and Medicaid telemedicine in the near future.

The Department of Veterans Affairs uses telemedicine technology extensively, especially in rural VA health centers and in mobile clinics.

Tuesday’s conference was organized and hosted by the Maine Telehealth Collaborative, a project of the Maine Center for Disease Control and Prevention, the Office of Rural Health and Primary Care and the Muskie School of Public Service at the University of Southern Maine.

Sponsors included a number of technology companies.


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