Editor’s Note: Dr. Jeffrey English, director of clinical research at the MS Center of Atlanta and former president of the Georgia chapter of Docs4PatientCare, talked with Health Care News Managing Editor Michael Hamilton about telemedicine’s record of delivering affordable, high-quality health care to patients with restricted access.
Hamilton: What motivated you to start treating patients by telemedicine?
English: I was treating a woman who was about to lose her insurance, and she said she wouldn’t be able to see me. I said, “Well, that’s crazy. I’ll see you for free.” Then my business manager told me that would be illegal due to Medicare laws. I couldn’t believe the government had laws that precluded me from taking care of somebody for free. I went on kind of a journey for two or three years learning health care policy rules and regulations.
I fell into telemedicine trying to fix cost and access. For multiple sclerosis, there were very few specialists outside Atlanta. People would take off work and travel four hours each way, and I would spend 20 minutes with them. This seemed crazy to me, so we started asking, “How do we expand [the] brick-and-mortar [model]? How do I train people four hours away to become MS specialists and interact with us?”
I had dabbled in telemedicine in the past, and the technology had gotten so good, it was the obvious way to do it. Telemedicine is going to be the single greatest invention that will affect cost and access in health care in the future.
Hamilton: Can and should telemedicine replace the brick-and-mortar model?
English: As a patient, I would always rather see a doctor in person, but telemedicine is next, then telephone, and then comes never seeing the doctor. I have so many patients who don’t have access. Right now, [as we speak,] I’m on a stroke call. If somebody has a stroke, it could take a neurologist two hours to get into a hospital. I can see them in five minutes.
I would say 30–40 percent of all consults to specialists are probably unnecessary and can be handled via telephone, computers, and telemedicine with highly trained primary care physicians.
Hamilton: Some fear telemedicine eliminates important patient assessment steps only in-person physicians can take.
English: Providers have to know their limitations: what they’re able to do and what they’re not. That doesn’t matter whether it’s in person. You’ve heard millions of stories about terrible interactions with physicians and nurses in hospitals. Some mistakes are due to incomplete patient history. I saw a lady [via telemedicine] yesterday who gets into the hospital from the nursing home. Well, no one’s there. There’s no family. She can’t talk. That’s a very hard exam, in person or not.
When seeing someone via telemedicine, I know my limitations. I usually will have a nurse or staff member on the other end that’s been trained to help us with the exam, but if I see something concerning, I’m smart enough to say, “You know what? You have an emergency room 20 miles down the road. You need to go there.”
Hamilton: How have technological advances improved telemedicine, and will this improvement continue?
English: I will get on my telemedicine-pedestal day in and day out because I used to handle patients only by telephone. I used to get calls from all these hospitals. I wouldn’t have access to the records. I couldn’t see the patient. I felt very uncomfortable when I would just have to listen to a doctor or nurse tell me a story about a patient four hours away.
Now, I can see the patient. We work with two different secure video networks. I can see the MRIs and CT scans in labs. It’s so much better than it was before.
I don’t think my children are going to go see a doctor for routine things in the future. They’ll go into a secure room in their office, get on the computer, and interact with a doctor, and the doctor had better be smart enough to say, “You know what, this isn’t strep throat. This is something worse, and you need to get to the hospital.”
Hamilton: How can state lawmakers facilitate the expansion of telemedicine for their constituents?
English: A lot of states are considering a compact making it easier for one body to preapprove doctors for practicing telemedicine within their borders. I have no problem with that. It’s moving that way. The American Telemedicine Association is doing a great job in that regard.
Hamilton: Are any government policies obstructing telemedicine from flourishing?
English: Let me give you an example of where the government is way behind. Medicare will pay for telemedicine services in rural areas. Many of my patients live in rural areas outside Valdosta, Georgia. But when they come to the telemedicine office in Valdosta, it’s not considered rural, where the actual machine is, so it’s not reimbursable.
The [Centers for Medicare and Medicaid Services] needs to streamline its rules to make patient access more efficient. This will save money and make it easier for patients.
Michael T. Hamilton ([email protected]) is The Heartland Institute’s research fellow for health care policy, managing editor of Health Care News, and author of the weekly Consumer Power Report.
Latoya Thomas and Gary Capistrant, “State Telemedicine Gaps Analysis: Coverage and Reimbursement,” American Telemedicine Association, January 2016: https://heartland.org/publications-resources/publications/state-telemedicine-gaps-analysis-coverage-and-reimbursement
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