Telemedicine in Gastroenterology – Does it make sense?

The growth of telemedicine is projected to range between 13 % to 19 % per year over the next 5 years. Health care organizations everywhere are investing in telehealth and, depending on the poll, between 68 % to 75 % of patients prefer a telehealth visit over an in-person visit. Reimbursement is now increasingly available, and many states have or will soon have so called parity laws that require that health plans reimburse telemedicine encounters at similar rates as in-person visits [i]. In addition, direct-to-consumer on-demand telemedicine is rapidly growing as more patients want the convenience of ‘seeing’ a physician on their terms and are willing to pay out of pocket [ii].

Telemedicine. Every field has its magazine. Click to visit.

Telemedicine not only for Primary and Urgent Care any more

Certain specialized services such as Dermatology outreach and so-called TeleStroke programs have a long history in telemedicine, but even specialties such as Gastroenterology can profit from telemedicine. There is an increasing realization that patients with serious chronic diseases, in GI, for example, patients with Inflammatory Bowel Disease or chronic liver disease, have better outcomes with closer monitoring, which is often inconvenient and time consuming for patients and providers alike. Telemonitoring and televisits have been shown to be effective in this regard, and a reason why these programs are increasingly adopted by health insurers [iii] [iv].

Where can I sign up for GI Telemedicine?

Implementing a telemedicine program for your practice can take many forms and should be well researched and planned. The American Telemedicine Association maintains a comprehensive library of resource toolkits, webinars and conference recordings [v] . Gastroenterologists have the option of creating their own independent DTC practice which is cash based, as for example, offered by American Well [vi] , can implement a clinic-wide third-party platform that (hopefully) integrates with their existing EHR for documentation and reimbursement purposes [vii] , or can become independent contractors for a number of start-ups that offer second opinion consultative services [viii] .

The future

There are still a number of roadblocks that need to be navigated, not least of them are the physician licensing requirements, before telemedicine can really take off. Physicians need to be licensed in the state where the patient resides [ix].  A partial solution to the licensing conundrum for telehealth is the Interstate Medical Licensure Compact. This is an expedited pathway to licensure for qualified physicians who wish to practice telemedicine in multiple participating states.

References:

[i] For a state-by-state comparison: American Telemedicine Association. Coverage and Reimbursement. February 2017

[ii] Comparing 11 top telehealth platforms: Company execs tout quality, safety, EHR integrations. Healthcare IT News. August 02, 2017.

[iii] Siegel CA. Transforming gastroenterology care with telemedicine. Gastroenterology. 2017 Apr 1;152(5):958-63.

[iv] Cross RK, Kane S. Integration of telemedicine into clinical gastroenterology and hepatology practice. Clinical Gastroenterology and Hepatology. 2017 Feb 1;15(2):175-81.

[v] http://learn.americantelemed.org/diweb/start

[vi] https://providers.americanwell.com/

[vii] See a list by Capterra.

[viii] For example: https://www.2nd.md/ and https://www.secondopinions.com/

[ix]  Some of the issues are discussed in this White Paper: Liberating Telemedicine: Options to Eliminate the State-Licensing Roadblock. Cato Institute. November 15, 2017.

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