AMA’s National Use Estimate on Telehealth

Late last year, the American Medical Association released a study compiled from two years of patient care and physician data. The research, published in Health Affairs, sought to create the first national use estimate on telehealth usage by healthcare providers. What did the study show? How is telehealth being used? Are usage trends increasing? What are the barriers experienced by small and large practice providers?

This article will review this data to determine what trends we can expect from telehealth in 2019 and beyond.

The AMA’s study couldn’t have come at a better time. By all estimates, telemedicine is increasingly popular, with the majority of health systems and community healthcare providers using virtual care to increase patient access and cut costs. But extensive barriers remain, particularly for small practices seeking to use these tools for competitive advantage. From state licensure to reimbursement, telehealth adoption remains a challenging option for healthcare providers that are not part of a large system.

While reimbursement is expanding and state licensure compacts are streamlining how doctors get credentialed, challenges remain. The AHA study confirmed this diagnosis, concluding, “despite regulatory and legislative changes to encourage the use of telemedicine, the financial burden of implementing it may be a continuing barrier for small practices.”

The AHA study surveyed 3,500 physicians to determine how telehealth is being used in their practices. The goal was to cull “needed data that will help assess potential barriers and create strategies to promote telemedicine adoption.” What were the findings of the study and what do they tell healthcare organizations seeking to use the virtual house call, remote monitoring, or the digital consult for care continuity to improve patient care?

The AHA results were published in December 2018. The data showed:

• National use of telehealth tools remains low.
  The survey showed that only 15% of the physicians surveyed used telehealth. These practices leveraged digital technologies to diagnose and treat patients, follow up, or manage chronic conditions. An additional 11% also used telehealth for care continuity via specialty consults with other providers.
• A variety of specialists use telemedicine technology.
  The survey sought to quantify how specialists use these tools. Radiologists remained the highest at nearly 40% (39.5%), while emergency medicine physicians came in second at 38.8%. 30.4% of pathologists used telehealth while psychiatrists came in fourth at 27.8%. Nearly 25% of radiologists use the tool about (25.5%) while just over 24% of cardiologists use telehealth (24.1%). The study determined that all other specialties use telemedicine from about 6% to 23%.
• Video conferencing was the most common treatment modality.
  The AHA’s research indicated that video conferencing was the most common method of using these virtual tools to interact with patients or between caregivers. 12.6% of all physicians that used telehealth in the study for transmission of pictures and voice in real-time to treat patients or share information with other clinicians. This technique was most common with ER physicians, followed by psychiatrists, and pathologists.The study also showed that store and forward, or asynchronous virtual visits were used next most frequently, primarily as a tool to aid in the diagnosis of patient conditions. For example, radiologists transmitted data to family practice physicians or cardiologists transmitted EKG readings. Radiologists used these tools most frequently overall the specialists studied.Finally, the third most used application of telehealth in the physician population studied was remote patient monitoring. It was most beneficial to cardiologists, followed by nephrologists, and neurologists.
• Physicians in small practices less likely to adopt telehealth.
  The study indicated that the smaller the practice, the less likely they were to use telehealth. These practices indicated a perceived financial burden for implementing these tools. Also, a factor was whether the practice was hospital-owned or independent. Independent small ambulatory facilities were the least likely to use these tools.

In response to these findings, the AMA stated:

The AMA is committed to making technology an asset, not a burden, and continues to invest in resources that provide physicians with a proven path for integrating telemedicine and digital health technologies into patient care.

The AMA launched their STEPS Forward™ how-to manual for practices seeking financial, operational, and clinical improvements. Within the toolkit is a telemedicine module specifically designed to teach the four steps necessary to adopt telemedicine in the small practice:

• The practice must familiarize itself with state and federal laws governing telehealth, including licensure and reimbursement rules. Other considerations include malpractice carrier agreements or private/public payer reimbursement guidelines. Are there special credentialing rules that must be considered?
• It should identify the target audience and the model for service delivery that meets the needs, wants, and priorities of the practice and their patients. How will the service be used? Will you provide direct care in real-time via video conferencing or will these tools monitor long-term chronic care conditions? Are you targeting existing patients? Will it be used to provide a second opinion or for care coordination?
• The practice team must also determine the technology and support necessary to implement telehealth. How will visits be scheduled? What type of support will be needed for this service? Will the patient be interacting via a smartphone app? Will you need peripheral devices to support the new service, such as an electronic stethoscope? Do you have enough IT bandwidth to support the service?
• They should understand the guidelines and best practices for initiating these new tools.
  Will data be encrypted and is the tool HIPAA-compliant? How will you capture informed consent? What is the emergency plan for if the technology fails or an escalation of care is needed?

In addition to these practice improvement guidelines, the AMA also backs up their research with the Digital Health Implementation Playbook. This free guide offers a 12-step process for implementing remote patient monitoring that uses sensors, trackers, and other digital devices to track patient outcomes when they are at home.

The AMA research illustrates that telehealth usage is still in the early stages, particularly in the small practice.

It’s clear that the AMA is both highly supportive of improved implementation of telehealth tools and committed to providing small hospitals and medical practices with the resources they need to use telemedicine. OrthoLive shares that commitment, with one of the first low-cost telehealth applications geared specifically for the orthopedic provider. Contact our team to discuss telehealth deployment in your practice today.