Major Medical Journal Discusses Telemedicine & ACA

Despite the Affordable Care Act’s rocky roll-out last October, more than 7 million Americans have signed on for health-care coverage through the Act as of March 31. Another 3 million have enrolled in state Medicaid plans, largely due to a provision of the Affordable Care Act (ACA) that subsidizes states’ expansions of Medicaid eligibility.

A major concern accompanying implementation of the ACA is the demand these millions of newly insured will place on the nation’s already inadequate physician supply.

But an article in the March 2014 issue of The American Journal of Medicine notes that advances in telemedicine, telehealth and mHealth (mobile health) services can help compensate for the physician shortage while meeting the ACA’s goal for increased health-care efficiency.

“The shifts of the health-care industry into new directions to accommodate the goals of the Affordable Care Act initiative should expand the practice and provision of health care at a distance,” states the article, authored by Ronald S. Weinstein, MD, and colleagues with the Arizona Telemedicine Program (ATP). Weinstein is co-founder and director of the ATP, which is based at the University of Arizona Health Sciences Center and has received funds from the Arizona Legislature since 1996.

The term “health care at a distance” refers to:

• Telemedicine, narrowly defined as clinical services provided by a physician
• Telehealth, which encompasses clinical services provided by nurses, pharmacists and other non-physicians
• mHealth services made possible by the proliferation of mobile communication devices, including smart phones, tablets and personal digital assistants, or PDAs

Weinstein and colleagues point to telemedicine’s proven track record in four categories of health care delivery:

• “Gap service coverage,” notably night-time teleradiology service to hospitals in rural communities
• Urgent services, including telestroke and teleburn programs that provide immediate diagnosis and treatment recommendations to physicians who are dealing with stroke and burn patients in remote areas
• Mandated services, including health care for prison inmates
• Video-enabled, multi-site group chart rounds, such as Extension for Community Healthcare Outcomes (ECHO) programs

Also driving the increased interest in telemedicine, telehealth and mHealth services is the increase in state laws requiring parity in third-party reimbursement for these services, now on the books in 19 states, including Arizona – where the state House and Senate both passed a parity bill in 2013, without a single "nay" vote.

In an accompanying editorial in the March 2014 American Journal of Medicine, Weinstein and colleagues Ana Maria Lopez, MD, MPH, medical director of the Arizona Telemedicine Program; and Elizabeth A. Krupinski, PhD, professor of radiology and director of the Southwest Telehealth Resource Center; suggest that telestroke care will become “the next teleradiology” due to telestroke’s proven ability to provide timely, life-saving care and reduce permanent disability and mortality in stroke patients.

“There are very exciting things going on in telemedicine, and more in the pipeline,” Weinstein said following publication of the article and editorial. “Our health-care system is changing, and people are more interested than before in having access to health care. Telemedicine changes the way medicine is practiced in ways that are very appealing.”