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Telemedicine’s Most Valuable Benefit: Location, Location, Location

COVID’s Silver Lining:
Accelerating the Adoption of Telemedicine


Article 5 in the “Reimagining Telemedicine” series
by Mark Mariotti
(President and CEO, TIMS Medical) 

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COVID’s Unexpected Silver Lining Source: CommercialIntegrator.com

As I foreshadowed in my earlier article “Telemedicine: Much More than Doctor-Patient Video Visits” 1 in July 2020, the range of applications for real-time, high quality video collaboration in hospital settings are growing rapidly. In this fifth installment of my collection of "Reimagining Telemedicine" articles, I’ll reiterate and expand on my earlier comment on the value of telemedicine, by noting that its adoption has been vastly accelerated by the worldwide impact of the COVID-19 epidemic.

Ironically, despite all the disruption that the coronavirus has brought (to hospital operations,
clinical diagnoses, the doctor-patient dialogue, and the daily lives of people around the globe),
with change comes innovation. Change has brought a surprising COVID-driven “silver lining”:

The widespread use and acceptance of telemedicine by all those whom it touches:
    • Medical Practitioners
    • Hospitals and Medical Centers
    • Medical Students
    • Health Insurance Underwriters/Payers, and last but certainly not least:
    • Patients (themselves)

COVID’s Impact on Telemedicine
Within the past year (March 2020-March 2021), COVID-19 has driven four major developments
related to telemedicine:
    1. Widespread deployment of live, remote video technology by healthcare innovators.
    2. Growing evidence of telehealth’s capacity to break down barriers (e.g., time, distance, access to medical expertise).
    3. Unprecedented delivery of quality care for patients who live in rural areas
    4. Increase support for telehealth expansion by insurers and U.S. government agencies.

Telemedicine: Eliminating Geographic Distance for Broader Access to Medical Expertise

Having written an article titled “Telemedicine: Much More than Doctor-Patient Video Visits” eight months ago, I was happily surprised to read a February 1, 2021 Forbes.com column with the eerily similar title of "Why Telemedicine Is Much More Than A Digital Doctor’s Office.”
Written by Robert Pearl, MD (Forbes contributor & former CEO of The Permanente Group, the nation’s largest managed care provider), the article begins with Dr. Pearl’s professional assessment that telemedicine technology “has the power to break down the barriers of time and distance, dramatically reduce healthcare costs and deliver top-notch medical expertise to people everywhere.” 2

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80% of visits at Kaiser Permanente today are some form of telehealth, including video visits.Source: Permanente.org

As multiple Kaiser Permanente facilities have been actively using our company’s telemedicine systems for years, I was delighted to read Dr. Pearl’s article and examples he cited of how telemedicine can make specialty care more efficient, eliminate geographic distance, and keep patients out of the ER.

Pearl’s Forbes articles are both informative and thought provoking. I particularly liked his February 2021 column saying telemedicine is underappreciated & underused by many in the medical world. Referencing how telehealth used by Kaiser Permanente physicians and staff, he does an excellent job confronting the healthcare status quo describing it as “cumbersome, redundant, time-consuming and expensive.”

Telemedicine’s Biggest Benefit: Location, Location, Location

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 Location, Location, Location. Source: Planhillsborough.org

While all of Dr. Pearl’s real-world examples are interesting, his observation “Telemedicine can eliminate geographic distance,” really resonated with me. From my perspective: Just like real estate, access to medical care is about “Location, Location, Location.”

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 Robert Pearl, MD. Source: Permanente Medical Group

As Kaiser Permanente and my company (TIMS Medical) have seen, a common question for patients who suffer from complex or unusual medical issues is “Who’s the best physician for my problem?” Unfortunately, unless that doctor is nearby, it’s unlikely the patient will be able to be diagnosed and treated by the “best” physician who may be hundreds/even thousands of miles away. Citing cases of how Kaiser patients have been served by urologists and pathologists through remote video telecollaborations, Dr. Pearl concludes: “Telemedicine provides a safe, high-quality, personalized and expert solution to the problem of geographic distance.”

Kaiser Permanente’s Leadership in Telemedicine

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Telemedicine: Convenience. Choice. Connectivity. Source: Permanente Medicine

While Dr. Pearl is no longer at the helm at The Permanente Medical Group, Kaiser Permanente continues to invest in telemedicine technology to increase the productivity and effectiveness of its physicians and staff to help improve care for its patients. KP succinctly describes how its investment in telemedicine technology benefits its members, their families, and caregivers in
just three words: Convenience. Choice. Connectivity

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Kaiser Permanente San Diego Medical Center. Source: Kaiser Permanente

If the topic of how Kaiser Permanente uses and benefits from real-time video and audio remote medical collaboration is of interest to you — please visit the Case Studies section of the TIMS.com website to read our Kaiser Permanente-Pathology TIMS Consultant Case Study. 

Helping Address the Urban/Rural Healthcare Divide

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Areas at least 30 minutes from a hospital - Source: New York Times

The spread of the coronavirus from urban areas into rural parts of the country has demonstrated that there’s long been a healthcare divide, as patients near cities have much better access to medical care than those who live far from a hospital. This issue doesn’t only affect low-population density states like Alaska & Wyoming. As the most populous state, you might not think California would face this issue, but in fact, it ranks at the top of all 50 states, with 794,000 residents living outside a 30-minute drive from the nearest hospital.

An April 2020 New York Times article (“Where Americans Live far from the ER”) interprets implications of the urban/rural healthcare divide writing it poses challenges for communities where hospitals are scarce and I.C.U. beds are in short supply even a relatively small outbreak there could overwhelm medical resources, with potentially grim consequences for public health. Research shows people are less likely to seek health care, even emergency care, when they need to travel farther to get it, especially when they are more than about 30 minutes from a hospital.”3

The Times article quotes Dr. Paul Delamater (University of North Carolina healthcare researcher) on the impact of distance on patient health: “We already know that people in rural regions who are located farther from health care use care less and generally have worse outcomes.”

COVID’s Impact on Support
for Telehealth Expansion from Insurers & Government

Beyond increased demand from patients and practitioners, and its use by more and more medical centers, one last crucial element driving the rapid expansion of telemedicine is the coverage of telehealth procedures by health insurance carriers, and related support by federal authorities that
provide and regulate healthcare services.

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CMS Rules and Payments for Telemedicine Procedures - Source: hccinstitute.org

To address the public health emergency caused by the nationwide coronavirus epidemic, at the end of 2021 the U.S. government’s Centers for Medicare and Medicaid Services (CMS) issued new regulations to expand coverage of telemedicine services.

As Health IT advisor & 30-yr. HHS alumnus Stanley Nachimson wrote in a December 7, 2020 article for ICD-10 Monitor: CMS’s “final rule adds more than 60 services to Medicare's telehealth list,” with CMS stating, ‘these additions allow beneficiaries in rural areas who are in a medical facility ... to continue to have access to telehealth services, such as certain types of emergency department visits, therapy services, and critical care services.’

Nachimson’s piece “Federal Authorities Adjusting Regulatory Requirements Ahead of 2021” 4 went on to describe that in the CMS Physician Fee Schedule Final Rule for 2021,“there are changes to evaluation and management (E&M) services and codes, including increasing the relative value of several services.”

Nachimson further explained: “Also, under this final rule, direct supervision can be provided using real-time, interactive audio/video technology through Dec. 31, 2021. And certain nonphysician practitioners, such as physician assistants and nurse practitioners, can supervise diagnostic testing if state law allows.”

Conclusion: Pandemics Bring Innovation
COVID-19 has accelerated the adoption of telemedicine

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“Pandemic”: 2020’s ‘Word of the Year’- Source: Dictionary.com

To say that COVID-19 has had a major negative impact on the health of people across the globe would be an understatement!

But as history surprisingly shows us, pandemics brings substantial change & innovation:
  • The Black Plague of the 1340s played a major role in the of introduction of the printing press, and subsequent access to books by the general population.
  • Similarly, had he not been “social distancing” in 1665-66 during the Great Plague of London, Isaac Newton may not have developed his theories of gravity and motion.
  • 100 years ago, the 1918 Influenza Pandemic (inaccurately dubbed the “Spanish Flu”) infected a third of the world’s population. While an estimated 50 million people died from the virus, that pandemic led physicians to think beyond just curing illnesses, and to also focus on what causes diseases to spread. Similarly, to prevent future epidemics, governments soon initiated public health policies that expanded access to healthcare for their citizens in years to come.

From the devastation wrought by smallpox and measles over centuries, up to HIV/AIDS, SARS and Ebola outbreaks over the past 40 years pestilence can also drive positive progress. While recent health crises caused worldwide chaos, the development of life-saving drugs and antibiotics, and the growing acceptance of video telecollaboration between remote clinicians are encouraging examples
of innovations in the midst of infection.

As this Newsweek video shows, “Pandemic was picked 2020’s ‘Word of the Year’ by Dictionary.com and Merriam-Webster. While not a surprise for all of us who survived the year that ended life as we know it the optimist in me hopes we can note that COVID also brought with it medical advances
that will improve healthcare in the future!

Despite all its tragic aspects, the 2020-21 COVID-19 pandemic has revealed a
healthcare “silver lining,” as it has necessitated remote medical care,
and accelerated the acceptance and adoption of telemedicine.

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About This Article and its Author
This original article “Telemedicine’s Most Valuable Benefit: Location, Location, Location is the fifth in a series of educational “Telemedicine Reimagined” articles published by TIMS Medical, Inc. 

Mark Mariotti, President/CEO, TIMS Medical & Foresight Imaging
E: mmariotti@tims.com  W: www.tims.com 

LI: https://www.linkedin.com/in/markdmariotti/  

#Tags: #Telemedicine #TelemedicineReimagined #Telehealth #LiveRemoteMedicalVideo #Telesurgery #Telementoring #Teleproctoring #RemoteCollaboration #RemoteMentoring #Innovation #TIMSConsultant #TIMSMedical #COVID-19 #coronavirus #pandemic #SilverLining #KaiserPermanente #RobertPearl

1 LinkedIn ‘Telemedicine Reimagined’ Article Mark Mariotti/TIMS Medical.
Telemedicine: Much More than Doctor-Patient Video Visits. July 2020.
Source: http://bit.ly/MoreThanZoom
2 Forbes.com Robert Pearl, MD.
Why Telemedicine Is Much More Than A Digital Doctor’s Office. February 1, 2021.
Source: bit.ly/2O2wv3v
3 New York Times Ella Koeze, Jugal K. Patel, Anjali Singhvi.
Where American Live Far From The ER. April 26, 2020.
Source: https://www.nytimes.com/interactive/2020/04/26/us/us-hospital-access-coronavirus.html
4 ICD-10 Monitor Stanley Nachimson, MS.
Federal Authorities Adjusting Regulatory Requirements Ahead of 2021. December 7, 2020.
Source: https://www.icd10monitor.com/federal-authorities-adjusting-regulatory-requirements-ahead-of-2021

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