Telehealth: Enabling small practices to serve as the “hub” for healthcare delivery
There is little question that small practices have faced a disproportionate number of challenges over the past 50 years. Most have seen fee schedules contract while costs expand, struggled to effectively serve a population with more chronic diseases and, as care for complex cases has migrated to large urban settings, been forced to manage multiple subspecialists who communicate via paper charts.
The principles guiding healthcare reform, however, may effect dramatic change in the role small practices and primary care physicians (PCP) play. Healthcare visionaries recognize that providers must collaborate and care must be coordinated if the industry is to address the crippling issues of access, quality and cost. Most scenarios position the PCP at the hub of this model – supported by the concept of connected medicine and enabling technologies. This concept is the patient-centered medical home, and a telehealth approach to this will be the most successful option.
Telehealth will accelerate progress toward coordinated care. In essence, small practices and PCPs will be able to routinely bring specialists, ancillary staff and practice-based care managers (supplied by insurance companies) into their practices in real time, via telephone, Internet and video conferencing. Specialists, no matter where they are located, can participate in a live consultation with the patient, PCPs and the office staff to create seamless care – facilitated by access to real-time data for medical decision making such as lab tests, diagnostic studies and electronic health records (EHRs). PCPs can provide post-procedure care locally, with surgeons conducting “virtual rounds” as appropriate. Members of care teams can simultaneously access a patient’s EHR via the Internet, and consult in teleconference to make decisions about care plans to be jointly executed and monitored.
With this level of interaction, small practices will discover three specific areas of opportunity:
Improving the quality of care they are able to deliver;
Strengthening the small practice’s bottom line; and
Enhancing their reputation and “brand” within their communities.
The focus on quality
With telehealth technologies, the right people – regardless of proximity – will be at the right place at the right time, with the right information readily available. This will offer a level of coherence previously unattainable because important information has typically been isolated in disparate and distant systems. Patients who might otherwise decide not to consult with a specialist because of the expense or inconvenience of traveling to a distant medical center now will have access to the care they need. Suitable care plans can be constructed jointly, with all clinical stakeholders involved in its development and its execution.
This unity makes it easier to spot potential problems – interactive medications, for instance, or co-morbidities – to reduce errors and increase safety. Likewise, it minimizes costly, unnecessary duplicate testing. All members of the care team, whether PCP, specialist or ancillary provider, are empowered to monitor compliance with care plans and disease management regimens.
Finding the bottom line
Among the greatest barriers to telehealth for cash-strapped small practices is the cost associated with the technology. The good news is that because telehealth is a bidirectional construct, other healthcare organizations may share or assume the costs. Some health plans, for example, provide telehealth resources to support practice-based care management programs. Medical centers and IDNs likewise see the value – both from a clinical and financial standpoint – of making their specialists more available to their referring base.
Telehealth also offers the potential to increase revenue. Labs, imaging and procedures such as stress tests or colonoscopies represent a source of income, for example. Because telehealth supports data sharing, small practices or rural hospitals will be able to provide income-producing services and make the results available to other providers—rather than sending the patient off to a specialist who then performs and is reimbursed for the tests.
Perhaps even more importantly is the idea that PCPs no longer need to “send their patients off” to another provider – perhaps never to get them back. Telehealth allows small practices to remain the primary resource for their patients and communities they serve.
Enhancing the brand
In today’s environment, patients are much more aware of the access-quality-cost equation than even before. Small practices on the leading edge of the issues will gain an advantage over other caregivers serving their communities. While high-touch care remains paramount, patients want to know that the best and most effective therapies are available to them.
Access to sophisticated and high-quality care through telehealth is further enhanced because it becomes convenient for the patient. Today, patients may need to take an entire day off of work, drive hours to an urban health center, and pay for gas and parking in a traffic-clogged city to see a specialist. Telehealth allows small practices to provide access to these resources right in their own community and puts the focus back on the patient receiving care when and where they want it.
Taking care of their own health becomes easier, too, when patients are not forced to be the coordinators of their own care. Currently, patients are being made responsible to schedule multiple appointments with multiple caregivers; hand-carry referral, orders, films and instructions from one provider to another; and, often, to relay highly detailed and clinical information. No other industry puts this burden on its customers. The retail, travel and financial communities, for instance, are committed to streamlining their processes, and pay great heed to customer service and satisfaction. Telehealth allows small practices to do the same, building patient loyalty, offering more accessible care and, in the world of home-care patients, receive transformative care without any travel at all.
There can be no doubt that the healthcare paradigm is changing and that small practices will play an increasingly important role in care delivery. Telehealth will allow them serve as an effective hub within connected healthcare models designed to address the challenges that threaten the effectiveness and sustainability of the industry today.
Andrew Watson, MD, MLITT, FACS, is the medical director of the Center for Connected Medicine in Pittsburgh.