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Virtual care for patients in need More Medical groups embracing use of telemedicine

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On a recent Sunday, a New Jersey woman awoke with an inflamed eye. Concerned it might be conjunctivitis, or pink eye, she quickly sought medical assistance. Considering the timing — a weekend morning in the middle of a brace of winter storms — her traditional choices would have been to wait it out until Monday or driving to an urgent-care center or the nearest hospital emergency room, either of which would mean a trip on icy roads and a long wait.

Instead, she used her smartphone to log onto a secure account on the website of Vanguard Medical Group, a primary care practice with multiple locations in New Jersey. She was immediately able to answer some online questions about her condition, then take a cellphone photo of her eye and upload it to the site.

The data was quickly dispatched to an on-call Vanguard physician, who reviewed the information, called the woman back and gave her a diagnosis, followed by an email with some treatment recommendations.

“If the physician had determined that she needed antibiotics or other medicine, a prescription would have been electronically submitted to her local pharmacy,” said Vanguard Chief Medical Officer Dr. Thomas McCarrick.

The procedure is called by different names, including telemedicine, eCare and telehealth — McCarrick’s service, which is available from 8 a.m. to 8 p.m. seven days a week, is branded as Vanguard eCare — but it all basically boils down to this: getting a medical consult from the convenience of your home with a smartphone, computer or tablet.

“On a busy day we might get 20 to 25 eCare logins,” he explained. “Vanguard Medical Group has been using a version of this technology since 2015. We started with one application, but it was designed for a much smaller practice (Vanguard has about 41 medical providers, including some 23 physicians), so we changed vendors about a year ago. We’re now speaking with our current vendor about another upgrade, to a live video platform.”

Vanguard generally charges a flat fee of $45 for a televisit; New Jersey insurers have to cover it, thanks to legislation passed last summer. But Vanguard waives the charge if the doctor determines the patient’s condition warrants an in-person visit.

“Telemedicine is good, since some people are more likely to check in with their own doctor if it’s convenient,” McCarrick said. “But it has limitations. A remote consult is good when symptoms present in a straightforward manner, but if they’re ambiguous or could be more serious, it won’t replace an in-person visit. Remote consults can be a good starting point, though.”

From a financial point of view, they’re not exactly a bonanza for medical practices, he added.

“On the one hand, remote consultations may increase the number of visits a patient has with the practice, which is good for patient engagement,” he said. “But we’re not making a lot of money on them (Vanguard currently is running a “free first visit” coupon promotion for remote consultations), and you still have the fixed costs of the software applications and training medical staff on how to use them. But if it promotes patient health, I’m all in favor of it.”

Though this service offers a new and innovative way of extending treatment to our patients, we recognize that not all conditions can safely be treated through virtual encounters."

Other medical providers are also shoring up their telemedicine activity. Inspira Health Network implemented Inspira eCare in October 2016 as “the initial offering in a virtual care platform geared toward increasing access points for our patients,” explained Dr. Evelyn Balogun, medical director of Inspira’s Urgent Care and Occupational Health and Employee Health.

“At the time, we envisioned the introduction of virtual care as a complement to services provided through our urgent care centers, but recognized future opportunities for other settings based on research that shows patients are increasingly seeking options for online and mobile delivery for their health care needs,” she said. “The addition of virtual visits enabled the network to provide that additional level of convenience to our patients.”

During the first year of service, some 817 patients accessed Inspira eCare for a variety of conditions. But Balogun said it’s not for everyone.

“Though this service offers a new and innovative way of extending treatment to our patients, we recognize that not all conditions can safely be treated through virtual encounters,” she said. “Cases not appropriate for virtual visits were redirected to the appropriate level of care.”

Dr. Evelyn Balogun, medical director of Inspira Health Network Urgent Care and Occupational Health and Employee Health
Dr. Evelyn Balogun, medical director of Inspira Health Network Urgent Care and Occupational Health and Employee Health

Patients, Balogun said, were pleased with the convenience.

“It has been our experience that patients have generally been very satisfied with the ease and convenience of using the platform,” she said. “Telemedicine helps to bridge the gaps between the mode of delivery, growing demand, greater flexibility and greater access.”

It can also save money.

“Studies suggest that there are opportunities for cost savings with these programs, and that care delivered through a virtual access point can result in cost savings in some cases when compared to in-person visits,” she noted. “But our purpose in exploring the opportunities in shifting routine in-person visits to the virtual care platform was not driven solely by cost. Again, this shift reflects the demand by consumers for more convenient options of care. It also enables expansion of clinical capacity and time efficiency, which to a provider could mean more time spent with complex patients.”

Tele-test

On Feb. 1, West Orange-based RWJBarnabas Health system plans to offer telemedicine to its 32,000 employees as a kind of test, before rolling it out to a larger general patient population.

This isn’t the organization’s first foray into telemedicine — RWJBarnabas Health already uses remote physician visits in its locations like Children's Specialized Hospital in New Brunswick, so sub-specialty physicians can diagnose more patients —but this will be the health system’s largest rollout to date.

“Since this is a new endeavor, we wanted to utilize a defined group in a controlled environment,” explained John Doll, CFO of RWJBarnabas Health. “We’re self-insured for health benefits, so this way we’re able to ensure uniform reimbursement treatment and we’ll be able to be sure that we can handle the volume before we open this up to the public, probably around April.”

The mammoth telehealth system is being built by American Well, a Boston company, according to Doll. He noted embedded software will determine co-pays and take care of insurance details once it’s unveiled to the general public.

Telemedicine may be able to reduce medical provider costs, “perhaps by saving a person from an unnecessary trip to the emergency room,” he added. “But in any case, we need to continue to adapt to expectations of patients.”

With digital technology as pervasive as it is, it would appear to be easy to implement a remote medical system. But there are some complex issues to deal with, according to Joseph Carr, head of healthcare information technology and chief information officer at the Princeton-based New Jersey Hospital Association.

One big concern, he pointed out, is ensuring a telehealth connection is compliant with the federal Health Insurance Portability and Accountability Act of 1996, which laid out regulations aimed at protecting the privacy and security of certain health information.

“So before a hospital or other medical provider contracts with a telehealth service, they have to engage in sufficient due diligence,” Carr said. “Telemedicine can be very efficient and it can be more economic, at least for a patient. But hospitals and other medical providers still have to maintain brick-and-mortar locations, and now they’re also paying for telemedical IT consulting services. Telemedicine, though, can deliver some efficiencies in an office environment.”

In some circumstances, it may be a lifesaver.

“If you can address certain issues early on, especially in behavioral health, it may have a very positive effect,” Carr explained. “Think about it, someone who is undergoing an episode can see a mental health professional right away, with no lag time. Right now, a patient has an episode, a loved one or someone else calls 911 and the police straps the individual into a stretcher and takes them to the emergency department, where he’s left on a gurney while everyone tries to figure out the next step. The experience alone can make you even more upset. If there’s a telemedicine option, a mental health professional may be able to talk the person down without aggravating the situation."

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