An essential tool for today’s health care, held back by yesterday’s rules
October 06, 2016
I have the privilege of leading one of Pennsylvania’s newest hospitals, Einstein Medical Center Montgomery.
I’m pleased to say that Einstein uses two-way communication technology to deliver health care in a new way. It’s called telehealth, or telemedicine, and it’s a bit like using FaceTime on an iPhone.
At Einstein Montgomery, we are using telehealth to provide effective, efficient, high-quality care for some of our sickest and most vulnerable patients, in our intensive care unit (ICU).
I’m excited about the possibilities of telehealth, but also a little frustrated. Setting up telehealth services takes longer and costs more than it has to. Outdated laws, regulations, and insurance practices are getting in the way.
How telehealth brought affordable intensive care to Einstein’s suburban patients
When the new hospital opened, many patients and their families were grateful that excellent intensive care was available closer to home, in a convenient suburban setting.
Recruiting the expert physicians needed to care for our ICU patients was difficult and cost-prohibitive, so we decided to implement a telehealth solution during overnight hours. This form of telehealth service brings skilled intensivists to a patient’s bedside—even though these physicians are located miles away in New York.
If a patient needs an ICU physician’s attention at night, the nurse on duty turns the patient’s flat-screen TV into a two-way communication portal. The patient can hear and see the off-site clinical team. The team can visit with the patient—zooming in as needed to check physical symptoms and clinical equipment.
With full access to the patient’s electronic health record (EHR), the on-site nurse and off-site team can review everything from the patient’s medical history to the latest test results.
Together, the nurse and remote team address health concerns and take the steps necessary to keep the patient safe and comfortable. The off-site team can order any medications or tests needed and document the patient’s progress directly through the EHR.
Success in the ICU leads to telestroke and “telecounseling”
With telehealth working so well in the ICU, we added telestroke services in our Emergency Department (ED) and inpatient units. Working out of the Philadelphia medical center or from their homes, Einstein-employed neurologists can quickly evaluate Einstein Montgomery patients who may have suffered strokes or are showing stroke-like symptoms.
Once again, we’re using telehealth to bring the right care to the right patients in the right setting—and at the right time. Starting treatment as quickly as possible is the key to minimizing the long-term effects of strokes.
We’re also considering the use of telehealth to provide counseling for patients with mental health conditions. Many people in crisis find that hospital EDs are the only place they can turn to. We want to use telehealth to connect these patients immediately with behavioral health specialists. Inpatients requiring consults for behavioral health services can also get these via telehealth.
To reduce telehealth paperwork, a physician licensing “common app”
Decades-old rules and regulations are slowing down how quickly we can adopt telehealth solutions like these.
The technology is “geography-agnostic.” With telehealth, physicians can connect to patients down the block or across the country with equal ease.
Unfortunately, physician licensing is state-bound. Physicians must complete a different, and lengthy, application process for every state they want to practice in.
The result, when it comes to telehealth, is that physicians must be licensed in all the states where their patients might reside.
I went through this process to get telehealth intensivists in New York ready to take care of our ICU patients here in Pennsylvania. The cumbersome, paper-and-fax-based procedures involved thousands of pages and hundreds of hours of work on the part of my staff.
Fortunately, Pennsylvania lawmakers, led by Rep. Jesse Topper and Sen. Tom Killion, have passed legislation to adopt the Interstate Medical Licensure Compact (House Bill1619). Hospitals expect that the Governor will sign this bill into law soon.
When Pennsylvania enacts the compact, physicians licensed here could use a common application to be licensed in all the other states (17 to date) that also have adopted the compact.
Telehealth payment parity to modernize insurers’ reimbursement models
Pennsylvania lawmakers are also considering telehealth parity legislation (House Bill 2267, sponsored by Rep. Marguerite Quinn, and Senate Bill 1342, sponsored by Sen. Elder Vogel). This law would require insurers to update their reimbursement practices to include telehealth.
If an insurer reimburses a health care service provided in-person, that insurer must also reimburse for that same service if it is provided via telehealth.
Some insurers already have telehealth payment policies in place. Independence Blue Cross, the leading insurer in southeastern Pennsylvania, has announced that they will reimburse for primary care delivered through telehealth.
Enacting broader, statewide telehealth parity would give Pennsylvania providers the confidence to invest in the planning, technology, and training needed to launch more telehealth services.
To date, 29 states require that private insurers cover telehealth the same as they cover in-person services. Pennsylvania patients and providers run the risk of falling behind.
A new technology that honors an old mission
Telehealth may be a new tool, one that we are still figuring out how to use to the greatest possible advantage. It’s remarkable then, how well this new technology complements and supports the mission that has served Einstein Healthcare Network so well for 150 years:
“With humanity, humility, and honor, to heal by providing exceptionally intelligent and responsive healthcare and education for as many as we can reach.”
Telehealth will help us take that mission forward now, and in the years to come.