By Chris Jaeger, head of ACO and health system strategy, AristaMD.
Rural hospitals are facing severe challenges in maintaining operating margin, with uncompensated care being a major factor. Telehealth eConsult platform use in local primary care settings to improve “right time, right place, right provider care” have been shown to decrease the number of patients receiving avoidable and unnecessary care within the hospital setting, thus supporting hospital’s ability to mitigate uncompensated care.
Uncompensated care is an overall measure of hospital care provided for which payment was not received from the patient or payer group. It equates to the sum of a hospital’s bad debt — the financial assistance it provides. Financial assistance includes care for which hospitals never expected to be reimbursed and care provided at a reduced cost for those in need. A hospital incurs bad debt when it cannot obtain re-imbursement for care provided; this happens when patients are unable to pay their bills, but do not apply for financial assistance, or are unwilling to pay their bills.
Hospitals, both nonprofit and for-profit, provide uncompensated care for individuals who are uninsured and under insured.
Though there has been a noted decline in uncompensated care since the 2014 passage of the Affordable Care Act and Medicaid expansion, this has not carried over to states not part of the expansion. States that expanded Medicaid to low-income adults under the ACA recognized a 47 percent decrease in uncompensated care costs, on average, compared to an 11 percent decrease in states that did not expand Medicaid.
(Coverage map as of Feb 2019)
Uncompensated care and dropping revenue margins are causing hospitals, especially in rural areas, to close. “While Medicaid expansion has improved all hospitals’ operating margins and total margins, the effect was particularly pronounced in rural areas,” noted a report from the Center on Budget and Policy Priorities. A recent study by the North Carolina Rural Health Research Program (NC-RHRP) at the University of North Carolina Cecil G. Sheps Center for Health Services Research (UNC-CH) showed that since 2010, 89 rural hospitals in 26 states have closed.
Much of this uncompensated care could be prevented through primary care intervention. A report, released by Premier, found that six common chronic conditions accounted for 60 percent of 24 million Emergency Department (ED) visits in 2017; out of that 60 percent, approximately one third of the visits (4.3 million) were likely preventable and could be treated in a less expensive outpatient setting.
Telehealth is a really exciting field with masses of opportunity to build successful companies and to help people quite literally all across the globe. Technology has afforded us the opportunity to administer all sorts of things at vast distances and now that includes medical help. It’s not a field without some issues though and plenty of people will find getting into telehealth quite complex and confusing. So, here are a few tips for starting out in this industry.
Pick an appropriate field
Telemedicine is limitless in some ways, limited in others. This is an area with some limitations. “There are only certain sorts of medicine which it is practical to apply to the telehealth model, not to mention legally speaking,” warns Shane Marlon, career manager at PaperFellows and AustralianReviewer. You have to be able to guarantee that whatever it is you are doing will be of use without needing an ‘in-the-flesh’ consultation. But you’ll be surprised at how long that list of applicable practices is!
Look to the future
Tech development moves very, very quickly so it’s safe to say that telehealth, as a rising industry, will look completely different in ten years’ time. Now, you’re not a prophet, nor are you a trend-predicting supercomputer. However, with a little research you will quickly ascertain which elements of telehealth are set to change and develop. To capitalize effectively on these when the time comes, you need to be preparing now. For example, more detailed consultations of patients will be possible in the future, so the list of applicable fields will increase, and you need to be ready for that.
Find telehealth professionals
Though it is a relatively new field, there are already telehealth specialists who are out there. These people will be immensely useful to you as you try and develop in the industry. It’s vital that you bring in some outside expertise into your team as you develop, since it is such a new field with so few precedents in place to ensure that you are doing the right things.
The Medical University of South Carolina (MUSC) has received a $3.6 million primary award for the SPROUT-CTSA Collaborative Telehealth Research Network. This five-year grant is focused on supporting the development of telehealth research efforts, metric development, identification of best practices and the development of collaborative policy and advocacy materials across the country. It builds on work underway as part of the SPROUT (Supporting Pediatric Research on Outcomes and Utilization of Telehealth) collaborative, an established network of institutions and pediatric providers operating within the American Academy of Pediatrics, which is a sub awardee of the grant. The other sub-awarded institutions are the University of Colorado – Children’s Hospital Colorado, Children’s Hospital of Philadelphia (CHOP), and Mercy Clinic in St. Louis, Missouri.
S. David McSwain, M.D.
“This is a huge step forward in the development of safe and impactful telehealth programs across the country,” said primary investigator for the grant S. David McSwain, M.D., MUSC Children’s Health physician and MUSC associate professor of pediatric critical care and chief medical information officer. “Academic research into the real impact of telehealth services is a critical component of developing and growing programs with the greatest potential to improve our health care system. Many physicians and other health care providers are hesitant about incorporating telehealth into their practices because it’s difficult to separate the theoretical benefits from the real value.”
In 2015, McSwain collaborated with a small group of pediatric physicians across the country to form SPROUT, which has since completed and published the nation’s first broad assessment of pediatric telehealth infrastructure across the country.
“That was a critical starting point,” said John Chuo, M.D., associate professor of clinical pediatrics at CHOP, co-chair of SPROUT and site primary investigator. “When we started SPROUT, we realized that we couldn’t conduct studies on pediatric telehealth unless we actually knew which institutions were providing which types of services. That information wasn’t readily available, so we made it our first investigation.”
While much anecdotal or small-scale evidence exists about the benefits of telehealth, including cost reduction, improved quality of care in some patient populations and improved access to care for some rural and underserved populations, barriers to fully demonstrating the gains made via telehealth care delivery persist. For example, there are few best practices in existence for conducting multisite telehealth research involving patient care outcomes, limited access to research trials for rural populations and limitations to care access for special populations such as children or the elderly.
“At the national level, there is no academic authority currently spearheading multi-center telehealth research studies,” said Christina Olson, M.D., assistant professor of pediatrics and site primary investigator at the University of Colorado – Children’s Hospital Colorado. “We have piecemeal efforts happening in terms of research, national policy development and payer guidelines. This network will provide tools, resources and guidance to accelerate the development of telehealth studies across the country. We will support champions of telehealth to become champions of research as well.”
The grant is a Collaborative Innovation award through the National Center for the Advancement of Translational Science (NCATS). The program will operate in collaboration with CTSA (Clinical and Translational Science Award) sites across the country to facilitate research development and support current and future telehealth researchers to develop projects and apply for funding. As opposed to supporting a specific clinical research study, this grant seeks to establish an easily accessible support structure around telehealth research: tools, resources, guidance, collaboration, education and advocacy materials that will be valuable to anyone across the country who wants to study telehealth programs.
“We expect this network to become the preeminent source for evidence-based policy and outcomes data,” said Brooke Yeager McSwain, M.Sc., R.R.T, health policy consultant for the project and manager of the South Carolina Children’s Telehealth Collaborative. “Our national and state legislators have seen the benefits of telehealth for certain populations and regions. We have to demonstrate to them that this works across the country and has the potential to dramatically impact health care delivery models, particularly in value-based care.”
Alison Curfman, M.D., medical director of pediatrics at Mercy Virtual and a co-investigator of the grant, spends much of her time thinking about better ways to partner with children and their families for overall better health. “We have to ensure that children have access to every type of care that they need at the right time, no matter where they live. The technology is here. The commitment of the early-adopters is here. Our next frontier is proving to other pediatric providers across the health care spectrum that telehealth is about so much more than convenience.”
InTouch Health, ranked 2019 Best in KLAS for Virtual Care Platforms, announced the release of the industry’s first fully integrated, end-to-end virtual care platform. Solo by InTouch delivers enterprise solutions to provide scalable, patient-centric telehealth for any use case in any setting – with packages enabling compelling price points for every situation.
Joseph M. DeVivo
“We’ve spent a lot of time listening to our customers and we heard their need for a truly integrated solution that allows a physician to have a virtual, everyday interaction with patients whether they are in the home, clinic, emergency room, inpatient in a hospital – anywhere on the care continuum locally or anywhere in the world with one platform,” said Joseph M. DeVivo, InTouch Health CEO. “Coming off the heels of winning Best in KLAS for Virtual Care Platforms, we want to continue solving our customer’s problems by delivering the most comprehensive capability on the market. The latest KLAS analysis further proved that there was an industry-wide need for EHR and third-party software integrations across platforms. In order to fill that gap, we created the next generation of our software platform to provide clinicians with an intuitive, web-based interaction that allows access to all of the tools they need through a single interface.”
With prominent healthcare leaders projecting that upwards of 50 percent of care can be delivered virtually, Solo by InTouch powers the first of its kind platform that healthcare providers can leverage for every type of user and use case, including direct-to-consumer, direct-to-patient, provider-to-provider, clinics, worksites, EDs, and more.
“Healthcare providers are facing an immense amount of pressure to retain and attract new patients from both inside the system and the external, new market entrants,” said Steve Cashman, chief commercial officer at InTouch Health. “Virtualizing their practices as appropriate creates an opportunity for providers and patients to connect in ways that can meaningfully improve quality, access, and cost. Solo by InTouch is the first of its kind integrated platform that considers health systems’ large investments in EMR systems and can offer capabilities to every user from simple follow ups, to ambulatory clinics, to emergent care.”
The new software platform runs through the proactively monitored InTouch Network and will provide the same clinical reliability InTouch customers know and trust. It will include an updated user interface for seamless virtual visits, IT integration capabilities designed for interoperability, and end-to-end care coordination, with newly-scaled pricing. Additional capabilities will also allow for the basic audio/video connections clinicians need to facilitate telehealth for low-acuity interactions, such as post-op follow-up with a patient and getting a second opinion from a colleague during a virtual visit. These new capabilities are designed to deliver the flexibility for all healthcare providers — from small practices to large health systems — to scale their telehealth services across basic, low-acuity interactions to life-saving, emergent consultations.
Thanks to the advent of technologies, we can witness irreversible changes in our daily life today. It is now easier to cope with our everyday routine because we have smart solutions that speed up the pace of our life and make it more convenient.
Healthcare is where technologies are expected to revolutionize treatment and research methods we are used to so much. Hence, we have prepared some technological trends that will make healthcare more advanced in 2019.
The Internet of Medical Things
The notion of The Internet of Medical Things (IoMT) is tightly connected with wearables. This technology is designed to transmit the patient’s data through various sensors and gadgets attached to the patient’s clothes or directly to their body. Fitness trackers and smart sensors are specifically elaborated to measure blood pressure, glucose level, pulse, heart rate, etc. Along with that, you can count calories you’ve burned, and miles walked.
Well, it doesn’t sound that innovative in 2019. But what makes it one of the most progressive trends is that the gathered data can be used in many various and innovative ways. For example, preventive medicine can benefit a lot with the help of IoMT. Research gets more accurate and timely, and it is even possible to prevent epidemics using the stats gathered in this way.
Anyway, if this is your college topic and you need thorough research of the field, you can consider getting case study help by ordering your paper online to ensure the highest quality and most accurate statistics.
Telehealth
Well … yes, consulting a doctor through your telly looks like a scene from one of those futuristic novels showing what the world would look like in the 21st century. In fact, it is what we have now. Modern technologies allow us to forget about hours spent in a clinic waiting for your doctor to invite you. That also includes waiting for the results of your tests.
Now you can consult any doctor in the world having a computer and an Internet connection. Imagine that you needed to see a reputable specialist in another country. It would be highly inconvenient to go all the way there just for a consultation. Firstly, you’d have to spend a lot of time. Secondly, you might need help to move around. And finally, it would be costly.
Today, you can contact your doctor from any spot in the world and get their consultation. It will not work in emergency cases, but it can work well if you need help with urgent but small issues. This is a good possibility for those who reside in far rural areas or require a highly specialized doctor to receive timely medical assistance.
The technology can also allow people to get consulted more frequently, which will improve the overall health of the population and establish better relations with doctors.
As technology continues to develop, artificial intelligence has taken leaps from a science-fiction fantasy to being included in everyday tasks. The telehealth industry is one of the newest industries to begin utilizing artificial intelligence, affecting everything from the distribution of electronic medical cards to personable interaction. As telehealth spreads across the United States, artificial intelligence is one of the most powerful forces shaping it.
Changing Diagnosis
One of the trickiest parts of telehealth is diagnosing any illness or issue. When so many ailments share an incredible amount of symptoms, doctors and medical professionals often need patient interaction to fully diagnose an issue. Artificial intelligence has begun to find ways around this and help to deliver accurate prognoses to patients.
Massive companies like Google have set their sights on the telehealth and e-health markets in recent years. Wearables allow doctors to diagnose issues from a distance by taking vitals such as body temperature and blood pressure. The inclusion of wearable smart gadgets keeps tabs on patients to help ensure that proper treatment is being adhered to as well, logging the data to help medical professionals gather all the data they need for treatment.
Connecting Health Cards
In a world so increasingly connected to the internet, there’s been a powerful increase in the use of electronic medical cards. Artificial intelligence is being trained to help advise patients in the best card and plan for them to keep a healthy balance between care and cost. Google’s efforts to use artificial intelligence as helpful assistants to medical professionals include being updated on card plans and working with patients to keep all parties as informed as possible.
Telehealth and electronic medical cards commonly go together, mostly due to their similar nature of an online-focused existence. This means that any advance in one field is likely to be tied to the other in some way. The training of artificial intelligence for telehealth provides a massive boon for those that utilize electronic medical cards for their health plans.
Improving Communication
When a patient is put on a new medication, keeping an accurate schedule can prove challenging. Studies show that as many as half of all patients fail to take their medicine on time, or at all. This is partially because so many patients fail to remember the new part of their daily regimen, allowing the important medicine to go forgotten.
Artificial intelligence is often utilized in speakers and home-based assistants to help with reminders. A common usage is to set a time each day where the AI will inform their patient to take their medicine. Some doctors have even begun having telehealth patients log their doses with artificial intelligence programs to keep real-time tabs on whether a patient is following the instructions they were given.
Telehealth has grown considerably over the last years and shows no signs of stopping. Through the utilization of electronic medical cards, telehealth provides an excellent alternative for those who may have difficulty travelling or otherwise reaching medical help. The ever-growing internet of things draws telehealth and artificial intelligence closer into an excellent combination for patients in need.
By Samant Virk, MD, CEO and co-founder, MediSprout.
Samant Virk
Ask a doctor why he or she decided to go into the field of medicine and their answers vary. Many want to help people and they have personal stories like a sick parent that motivated them to become a physician. Others may come from a long line of doctors in their family and it’s a real point of pride. But, one thing is very clear, you likely won’t find a doctor who answers that question with, “So I could deal with insurance companies or get great at filling out the electronic health record (EHR).”
The cold truth is that in 2019 doctors spend more time filling out paperwork, playing phone tag, navigating federal and state mandates, and dealing with medication authorizations than they do helping their patients. Doctors spend only a fraction of their time actually building a better doctor/patient relationship and treating people. It’s hard to pinpoint when the doctor/patient relationship inextricably changed. But it’s estimated that doctors today spend just 27 percent of their time with patients.
Perhaps the biggest disappointment in healthcare is technology. We’ve all heard the “Oh how wonderful this new system is, it will change your world and healthcare for the better.” Rather than help us be better doctors who are able to assist a greater number of patients more effectively, it has created barriers and reduced our impact, interfering with one of the most essential parts of healthcare in which we were trained — communicating with our patients.
That’s because the technology is actually designed to reduce costs by leveraging data collected from government-mandated EHR rather than toward actually making patients feel better by addressing their medical needs.
Just like Uber disrupted the taxi industry and fintech is disrupting financial services, our practices need disrupting, too. And I believe it should be an inside job. Start-ups with 20-something computer geniuses are clearly brilliant, but the start-up model of launch, fail, re-launch won’t work for doctors. In healthcare, there is little room, or tolerance, for error.
By Danielle K. Roberts, a Medicare insurance expert and co-founder, Boomer Benefits.
Danielle Kunkle Roberts
The telehealth revolution gives health providers the opportunity to assist patients in remote or rural areas; the same kind of care that they give to patients in person. It saves money on travel and improves efficiency in healthcare as well.
While telehealth options in healthcare are helpful to individuals at any stage in life, they can be particularly helpful in treating older adults with chronic illnesses. The Centers for Medicare and Medicaid Services have recognized this and have put together guidelines for primary care physicians who treat patients in geographical areas where it may be difficult for those beneficiaries to otherwise gain access to certain specialists and medical experts.
Telehealth services are made available to these Medicare beneficiaries who have signed up for Medicare Part B. Here’s how Medicare covers telemedicine for these people.
Medicare outpatient coverage for telemedicine
Medicare has two original parts: Part A hospital coverage and Part B outpatient coverage. Telehealth services fall under Part B. Medicare Part B will cover a telehealth consultation whenever a consultation is medically necessary, and your Medicare doctor follows the guidelines in arranging the consultation.
The specialist must conduct your teleconsultation using two-way interactive communication that must include both live audio and video feeds. Fortunately, with the prevalence of digital technologies and telehealth platforms, this has become common practice for most healthcare organizations.
The Medicare beneficiary needs to live within designated rural areas, and the video conferencing call must be held at a designated originating site. Approved originating sites include your physician’s office or rural health clinic. Calls can also be conducted from within a federally qualified health center, a skilled nursing facility, inpatient hospital, critical access hospital or community mental health facility.
Thanks to the advent of technologies, we can witness irreversible changes in our daily life today. It is now easier to cope with our everyday routine because we have smart solutions that speed up the pace of our life and make it more convenient.
As technology continues to develop, artificial intelligence has taken leaps from a science-fiction fantasy to being included in everyday tasks. The telehealth industry is one of the newest 
