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Tuesday Dec 08, 2015

Barriers Hindering Use of Telemedicine

The Jan. 17, 1960 edition of the comic strip Our New Age(www.healthcareitnews.com) by Athelstan Spilhaus provided a glimpse into the future of technology in health care -- at least as envisioned by the scientist.  

Although the comic strip did not coin the term "telemedicine," it did portray a future where a patient might have an encounter with a physician who was not physically present in the room with the patient. The comic strip reflects the country's fascination with science that existed in the 1960s, but interestingly, it does accurately capture a scenario where a patient receives a diagnosis and treatment plan from a physician without actually being physically seen by the physician. Today, we refer to this type of patient-physician interaction as telemedicine.  

Historically, telemedicine has been viewed as a modality that could extend health care services to rural and frontier communities. This led to telemedicine primarily being used in one of three ways: remote monitoring, store-and-forward digital imaging evaluation, and consultation with specialty physicians. During the past decade, as technology has become more readily available and inexpensive, interest in expanding the use of telemedicine and other digital health platforms has grown among both patients and physicians. This increase in interest has led to corresponding increased interest among policymakers, payers, and regulatory agencies about how to regulate and compensate telemedicine in an evolving health care system.

The AAFP first established policy on telemedicine in 1994. This policy was modified and reaffirmed by the Congress of Delegates in 2010 and 2015. It reflects the value of telemedicine as a means of extending timely access to physicians, especially for those in underserved or rural communities. The policy also reflects concerns about the appropriate and ethical use of telemedicine and ensuring that telemedicine does not supplant a continuous relationship with a family physician.  

The policy also expresses our strong support for adequate payment.

Sensing the growing interest in telemedicine, the AAFP's Robert Graham Center for Policy Studies in Family Medicine and Primary Care(www.graham-center.org) opened a research portfolio on the issue. During the past two years, the Graham Center has engaged in a comprehensive analysis of the views and opinions of family physicians about telehealth and telemedicine. The project, conducted through a funding partnership with Anthem, produced a report entitled: “Family Physicians and Telehealth: Findings from a National Survey(www.graham-center.org).”

Here are the key findings of the report:

  • Fifteen percent of family physicians have used telehealth in the past 12 months. The most frequent users were isolated rural practices (29 percent as compared to 11 percent in urban settings).
  • Family physicians that use telehealth are more likely to practice in a rural location, be younger, have practiced for 10 or fewer years, and employ an electronic health record.
  • Among users, the most common clinical uses were for diagnosis and treatment (55 percent), chronic disease management (26 percent) and follow-up with patients (21 percent).
  • Barriers to using telehealth include the cost of equipment, lack of training, and the lack of payment for such services.
  • There were some differences in opinions among users and non-users of telehealth. Specifically, 89 percent of users agreed that telehealth improves access for patients while 77 percent of non-users felt this was true. The most substantive differences between users and non-users were associated with patient preferences. When asked if patients prefer to see a physician in person, 94 percent of non-users said yes, while only 82 percent of users agreed with this statement.
  • More than 85 percent of all respondents (users and non-users) agreed that they would use telehealth if they were adequately paid for such services.  

The report summarizes the analysis as follows: "Overall, the findings of this survey confirm that family physicians see promise in the ability of telehealth to improve access to primary care services. The findings also suggest that telehealth is on the cusp of advancing from a tool used occasionally to a tool implemented on a routine basis.  However, use of telehealth services will not become widely adopted until health systems are reformed to address barriers."

The Graham Center and Anthem recently received a Robert Wood Johnson Foundation grant(www.academyhealth.org) to extend their collaboration and research on telemedicine. Results from this second study will be published in spring 2017 .

Wonk Hard
On Dec. 2, CMS released the 2014 National Health Expenditure Accounts(www.cms.gov). According to this report, in 2014, health care spending increased 5.3 percent breaking a five-year trend of lower than expected spending growth. Total spending on health care now exceeds $3 trillion and represents 17.5 percent of the gross domestic product. Per capita spending increased 4.5 percent to $9,523. Pharmaceutical spending increased 12.2 percent in 2014 accounting for $297.7 billion in total spend. Hospital spending increased 4.1 percent accounting for 971.8 billion in 2014, and physician and clinical services increased 4.6 percent accounting for $603.7 billion in total spends.

Although the spending numbers will garner the most attention, we should not overlook the fact that the number of uninsured individuals fell by 8.7 million, a decline of 19.5 percent. The percentage of the population that is insured now sits at 88.8 percent, the highest percentage since 1987.

Posted at 07:00AM Dec 08, 2015 by Shawn Martin

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Shawn Martin, AAFP Senior Vice President of Advocacy, Practice Advancement and Policy.

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The opinions and views expressed here are those of the authors and do not necessarily represent or reflect the opinions and views of the American Academy of Family Physicians. This blog is not intended to provide medical, financial, or legal advice. All comments are moderated and will be removed if they violate our Terms of Use.