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(HealthNewsDigest.com) – While national trends are pushing adoption of telemedicine across the country and patient demand is growing, barriers including lack of standards of care, insurance payment, and patient trust levels may be slowing progress in Pennsylvania.
“Pennsylvania has the technology and the clinical expertise to be a leader in telemedicine,” says Karen Rizzo MD, president of the Pennsylvania Medical Society (PAMED) and a practicing otolaryngologist (ENT) from Lancaster.
“We just don’t have the right state insurance laws and the public just hasn’t had a chance to experience it. We need to do a better job of educating politicians and the public.” Telemedicine, according to Dennis Olmstead, chief strategy officer & medical economist at PAMED, as it pertains to the delivery of health care services, means the practice, by a duly licensed physician or other health care provider acting within the scope of such provider’s practice, of health delivery, diagnosis, consultation, treatment, or transfer of medical data by means of audio, video, or data communications which are used during a medical visit with a patient. Technology often used in telemedicine includes two-way video, wearable devices, smart phones, and wireless tools. It can be used for specialist referral services and consultations, remote patient monitoring, and consumer health education.
“The full use of telemedicine is part of the answer to helping thousands of Pennsylvanians living in areas of the state that are considered medically underserved,” says G. Alan Yeasted, M.D., FACP, president of the Pennsylvania Chapter of the American College of Physicians and a practicing internal medicine specialist in Pittsburgh.
“But as we can see from the September 2014 American Telemedicine Association report card and the March 2015 Pennsylvania Patient Poll, we have plenty of work to get done here.” The most glaring problem for Pennsylvania identified in an American Telemedicine Association report card deals with private health insurance for which the state received an “F.” Pennsylvania has no telemedicine parity law. In other words, insurance companies do not treat telemedicine as an equal service to in-person services. Specifically, insurance coverage for telemedicine services is not available or barely exists, and thus discourages providers and patients from using the technology. Not helping matters are the grades for parity that Medicaid and the State Employee Health Plan received – C and F respectively.
“When you think of a rural community that lacks specialties like psychiatry, dermatology, and cardiology, the use of telemedicine could be quite valuable,” says Robert Elden Wilson, MD, PhD, of the Pennsylvania Psychiatric Society. “But since telemedicine isn’t treated the same as an in-person physician visit from an insurance perspective, there’s little coverage and patients could face out-of-pocket expenses which may not be affordable.” However, Dr. Wilson, a child and adolescent psychiatrist practicing in Erie, adds that telepsychiatry – telemedicine specific for psychiatry – is beginning to be used to provide psychiatric management in rural parts of the state where it is difficult to secure adequate in-person psychiatric time. “While some patients were somewhat skeptical at first, they generally found the interaction with the telepsychiatrist beneficial and their comfort level with the process quickly increased” Dr. Wilson says. “Treatment results have been as good as traditionally delivered care.” But, overall public understanding of telemedicine is a factor that could also be slowing down telemedicine adoption in Pennsylvania. The Pennsylvania Patient Poll, conducted March 6 through 12 by Susquehanna Polling and commissioned by PAMED suggests that patients view in-person appointments with physicians as more important than using telecommunications opportunities. When asked how important it is to see a doctor in person as opposed to seeing a doctor through telemedicine, Pennsylvanians overwhelmingly say in-person meetings are either very important or somewhat important. Only six percent indicated they are not important. But, 50 percent indicated that they would use videoconferencing from the comfort of their home to see a doctor, and 49 percent said they would trust a diagnosis delivered by video conferencing. These statistics suggest that about half of Pennsylvanians are willing to try it. In addition 58 percent say they likely would use email or the Internet to consult with their physician.
“Once Pennsylvanian’s have a chance to experience telemedicine and understand its value, I imagine more would be willing to use telemedicine as the word spreads,” says PAMED’s Dr. Rizzo. “Barriers like insurance coverage are holding up opportunities for Pennsylvania patients to fully engage and experience telemedicine.” This is unfortunate, says Srinivas Murali, MD, FACC, president of the Pennsylvania Chapter of the American College of Cardiology. Already, he says there are nearly 1 million Americans currently using remote cardiac monitors, and nationally there are about 200 telemedicine networks and 3,500 service sites assisting patients with numerous health conditions including chronic diseases. “There’s plenty of peer-reviewed research that shows the cost effectiveness of telemedicine in addition to scientific studies indicating the use of telemedicine has resulted in improved care,” says Dr. Murali, who practices in Pittsburgh.
“Pennsylvanians particularly those with chronic diseases would benefit from increased use of telemedicine, but first state insurance laws need to be changed to give residents and health care teams a chance to try it.”
According to PAMED’s Olmstead, a telehealth task force, consisting of a variety of medical specialists from throughout the state, has been convened by the medical society to push for standards in licensure, telemedicine practice principles, and payment parity in the Keystone State. Chairing the task force is Marilyn Heine, MD, a hematology oncology specialist from Bucks County and a past president of the organization. “There’s interest among Pennsylvania physicians to advance telemedicine use in our state in ways to best serve out patients,” says Dr. Heine, who represents the Pennsylvania Society of Oncology and Hematology on the task force. “Legislatively, laws need to be updated so that our residents can safely enjoy the benefits of this technology like patients in many other states.”
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