Viewpoints: Telemedicine is part of the solution for expanding health care

12/29/2013 12:00 AM

12/27/2013 8:06 PM

A few years ago, I began to consider a career in medicine. I wanted to learn more about the day-to-day life of a doctor, so I started shadowing a physician in Sacramento. My first experience was typical. The doctor chatted with the patient, discussed his condition and came up with a plan. It was unremarkable in every way except that the patient was in San Diego – 500 miles away. The entire appointment was done via videoconference.

Telemedicine has been the “next big thing” in medicine for decades. It’s a simple idea – advances in communications technology create the opportunity to remotely provide patient care. Yet despite its potential, telemedicine has had a slow path to adoption. A study published last year identified three major barriers to the expansion of telemedicine: issues with physician reimbursement, licensing and credentialing.

As health care reform moves forward, it has become more and more crucial to find ways to address these barriers. Prioritizing telemedicine implementation has recently become especially pertinent for three reasons.

First, the research is in: telemedicine works. Several analyses over the past few years have shown that telemedicine is cost-effective across a range of different specialties. Patients report satisfaction with their care as well – a study from the UC Davis Medical Center found that many patients reported increased satisfaction from teledermatology services compared to traditional care.

Second, telemedicine embraces today’s reality of digital interaction. As a medical student, it is obvious to me that the next generation of providers (and patients) will rely on electronic communication. I can attest to the fact that a majority of my classmates choose to watch lecture videos online rather than coming to class.

But instead of simply transmitting information to us online, medical schools could teach us how to convey information electronically. Students currently in the medical education pipeline started using smartphones and Skype in high school. The same can be said for many patients. Telemedicine can translate that familiarity with communications technology into a meaningful doctor-patient relationship.

Finally, and perhaps most importantly, telemedicine can help address the much feared physician shortage. Policy experts predict an undersupply of physicians in coming years for two reasons. First, coverage expansions under the Affordable Care Act will add millions of patients to the health care system. And second, the U.S. population is aging. As people get older, they will need more care.

Reformers have proposed dozens of solutions to the physician shortage, most of which rely on increasing the supply of physicians. These include proposals to build more medical schools, bring in doctors from abroad and increase the scope-of-practice of midlevel practitioners.

But addressing the physician shortage does not require expensive investments in new schools or diluting the rigorous training that physicians in the United States receive. It can be done by increasing the productivity of the existing physician work force.

It is not difficult to envision how telemedicine can help make this happen. With videoconferencing, patients in rural areas will not have to travel long distances to be seen at urban medical centers. Physicians in visual specialties (e.g., dermatology) can see patients quickly and efficiently by evaluating pictures. And tools that remotely monitor vital signs free physicians to see patients in need of critical care by eliminating redundant checkups.

The recent political engagement with health care reform has highlighted many of the challenges surrounding health care. There are two schools of thought on how to address these challenges. One line of thinking is to overhaul the entire system with exciting new, but largely untested, ideas.

The other approach is to maximize the efficiency of existing delivery systems. What’s most compelling about telemedicine is that it would be relatively easy to implement.

Consider the issues I mentioned earlier: reimbursement, licensing and credentialing. Federal policy can set an example of reimbursement through Medicare – a House bill aimed to do so, but has failed to move forward. Additionally, some states mandate that private insurers cover telemedicine – this approach should be expanded. Licensing may be addressed through interstate licensing agreements for physicians who practice telemedicine. And credentialing to ensure competence in telemedicine practice can be incorporated into medical training and continuing education.

The time is right for telemedicine expansion – there is both a need and an opportunity. Straightforward reforms that standardize policy have the potential to make a big impact.

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