A new study provides ammunition for members of Congress who hope to expand health coverage, both private and public, to cover telemedicine, remote health services that keep patients in their homes.
Telemedicine or telehealth services allow patients to attend a digital “visit” with their doctors from home, which begins with a video chat or phone call with a physician who is out of reach. The patient describes his or her symptoms and the physician creates a care plan.
Telemedicine technologies improve patient quality of life and decrease time in the hospital, particularly for late-stage cancer patients, Drs. Andrea Cheville, Timothy Moynihan, and Jeph Herrin found in a new study published in JAMA Oncology, a peer-reviewed journal of the American Medical Association.
Remote technology monitors patients’ vital signs and any symptoms of impending problems, such as shortness of breath or pain, and can connect patients to local clinics with access to specialists via video conference.
Cheville says she hopes the empirical evidence will encourage lawmakers to consider expanding access to telemedicine services.
“I think we have a lot of work to do to give providers and policymakers information about what should be covered, what types of care, and for whom,” Cheville said. “That’s where we need to grow the evidence base, so we can understand whether there are things that just don’t translate to telecare.”
Late-stage cancer patients undergoing telemedicine treatments spend less time traveling to inpatient medical centers, which can equal hours spent in the car rather than in the comfort of their own homes. Traveling, especially over long distances, can be taxing for chronically ill patients, adding stress on top of debilitating illness.
For example, a cancer patient living in Jersey City, N.J., would spend at least one hour each way, longer with city traffic, to get to Memorial Sloan Kettering Cancer Center in New York City for an in-person visit. The trip would also include spending $30 to go to and from Manhattan via the Holland Tunnel for just one appointment. The logistics can be daunting and stressful for someone already suffering with a grave illness.
“One of the salient strengths of telecare is that we can monitor patients in a continuous way,” Cheville said. “If we are starting to identify a signal that something is wrong, many times we are able to recognize that signal, gather additional information in a proactive way rather than a reactive one.”
Telemedicine has support in Congress. For instance, Sen. Cory Gardner, R-Colo., has introduced legislation, the Telehealth Innovation and Improvement Act of 2019, which would require the Center for Medicare and Medicaid Innovation to measure positive outcomes of telehealth services for Medicare beneficiaries and would require the Health and Human Services secretary to compile a budget report to show whether telemedicine coverage could be funded in the long term.
Gardner’s bill has yet to be debated on the Senate floor.
Upon introducing it, Gardner said the bill would “increase access for people living in rural America” and would “incentivize the healthcare industry to develop new technologies that could potentially reduce costs and improve patient health.”
The bill’s sole co-sponsor, Sen. Gary Peters, D-Mich., said the initiative would allow people in rural, medically underserved areas to access medical care that would otherwise be difficult or impossible to obtain. “We must ensure that people living in rural areas have equal access to the quality healthcare,” he said.
More legislators have become interested in telecare in recent years. The Congressional Telehealth Caucus, which launched in May 2017, is asking providers and stakeholders for suggestions on how telemedicine policies might be enacted.
President Trump has supported expansion of telemedicine since the start of his term in office.
Former Department of Veterans Affairs Secretary David Shulkin, with Trump, announced three initiatives to make telemedicine technology available to veterans in August 2017. He authorized VA providers to expand telecare services to veterans regardless of geographic location, rolled out a new app called VA Video Connect that lets users access care on mobile phones, and set up an appointment scheduling app for veterans called Veteran Appointment Request.
The VA’s three-part plan was finalized and added to the Federal Register in May 2018.
“This will significantly expand access to care for our Veterans, especially for those who need help in the area of mental health … and also in suicide prevention,” Trump said in a White House statement. “It will make a tremendous difference for the Veterans in rural locations.”
Cheville studied a model in which telecare was combined with in-person physical and occupational therapy sessions. The results showed the benefits of regular monitoring of patients’ health statistics and check-ins with professionals either over the phone or through video chats.
Still, she stressed that greater research like her study is necessary to pinpoint which conditions would be best served by telemedicine. Without the empirical proof, Cheville says, politicians will face continued roadblocks to make their case for telecare in Congress.
Despite the long road ahead to enacting comprehensive telecare measures, Cheville said, “There’s no doubt in my mind that there are contexts where it will lead to better outcomes.”
