Feature Story

The Doctor Is In: Telemedicine Boosting Healthcare in Rural Communities

Telemedicine has been around in some form for almost 40 years – and it's now increasingly becoming a cost-effective and indispensable tool for doctors, rural hospitals, and local and regional governmental agencies situated in rural areas.

Today, according to the American Telemedicine Association, more than 10 million Americans use telemedicine. And adoption is growing. Kalarama Information, a market-research firm that focuses on the biotechnology, healthcare, medical devices, and pharmaceutical industries, indicated that telemedicine revenues have grown from US $4.2 billion in 2007 to more than $11 billion last year.

And a report by the Center for Connected Health (CCH) issued in February also highlighted a few other market trends – adoption numbers are significantly higher at hospitals located in more rural areas compared to urban areas, and the highest (Alaska) and lowest (Rhode Island) adopting states all had fairly small populations.

"These facts suggest that factors beyond the number of hospitals in the state, such as state policies, affect the proportion of hospitals that offer telemedicine," said Joseph Kvedar, MD, director at CCH.

In addition, reported Alex Kane Rudansky in Information Week, the financial pressures hospitals experience in today's changing reimbursement landscape are also fueling telemedicine's growth.

"Under the Affordable Care Act, the Centers for Medicare and Medicaid Services are reducing reimbursements to hospitals with excess readmissions…telemedicine consultations from a rural hospital to a larger medical center can result in a more accurate diagnosis and better treatment on the initial hospital visit, reducing the chances of readmission," said Rudansky.

Telemedicine, added Rudansky, not only drives money, but also drives revenue.

"Specialists order tests, labs, and prescriptions. With telemedicine, those dollars stay at the rural site, where the tests are performed," said Rudansky.

So how can we make better use of telemedicine in rural areas? A few years ago, the UnitedHealth Center for Health Reform & Modernization published a report, 'Modernizing Rural Health Care: Coverage, Quality and Innovation.' The report suggested these eight strategies:

Expand broadband connectivity to enable growth of telemedicine adoption.
Improve and align reimbursement approaches across payers.
Offer education and support to encourage physicians to incorporate telemedicine into their practices.
Use telemedicine to build primary care capacity. Telemedicine makes it easier for primary care physicians to connect with and monitor their patients, increases the availability of specialists in rural areas, and allows nurse practitioners and physician assistants to work under a physician's supervision to bring healthcare to more locations.
Increase rural healthcare choices by offering consumers such varied telemedicine applications as video consultations, online care and patient kiosks.
Raise patient comfort levels with telemedicine by encouraging the use of tools like remote monitoring, which can lead to greater patient engagement in managing their own health.
Update regulations so telemedicine providers can work over wide geographic areas and across state lines.
Improve care coordination and patient safety by using telemedicine to enable greater follow-up after surgery, reduce the need for patient transfers, improve the speed and effectiveness of emergency care, and connect professionals to each other and to relevant health data.

Here's one practical example that illustrates how telemedicine can be utilized not only by rural hospitals, but by local governments. According to the Scottsbluff Star-Herald, the county jail in Madison, Nebraska, has used telemedicine for its regular checkups since late 2009.

The jail has bed space for 111 inmates – 91 for males, 20 for females. The telemedicine system, supplied by AET, includes a cart with a 26-inch display, HD camera, speaker phone, physiologic monitor, diagnostic camera with otoscope, and three magnification scopes for throat, skin, eyes, and ears.

Jail administrator Terry Kotrous, a captain with the Madison County Sheriff's Office, said the nearest hospital from the jail is about 15 miles away in Norfolk. Inmates wanting some relative freedom commonly faked illnesses before the county started using its telemedicine system, Kotrous said. Since then, he said, that practice mostly has stopped.

In its first year with the system, the jail's medical expenses decreased by more than 50 percent, Kotrous added. The county now saves at least US $750 when they don't have to take an inmate to a local hospital for treatment and doctor visits can be completed without leaving the secure area of the facility – safety issues become nonexistent. The correctional facility has also lowered travel expenditures, which can include escorting officers' time and operating costs of county vehicles.

In short, telemedicine is helping to improve the quality of care for rural patients, particularly when data suggest that they face the greatest outcome disparities in emergency situations, noted Dr. Peter Kaboli, director of the Veterans Rural Health Resource Center at the Veterans Affairs Office of Rural Health.

"If you're a small critical-care hospital, you're not going to have a cardiologist standing by waiting for someone to come in with a myocardial infarction," said Kaboli.

Questions? Comments? I welcome both – reach me at kwvrbicky@aetmedical.net.

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