reprint

If primary care in the United States is going to help reduce healthcare costs and improve outcomes, then patients must be allowed to receive care in their own home via telehealth technology.

That’s the message Sapna Kripalani, MD, assistant professor of medicine at Vanderbilt University Medical Center, delivered on Tuesday in testimony before the Senate health committee.

“We should invest in innovative models of healthcare delivery that enhance access and convenience such as home telehealth,” Kripalani told lawmakers. “Home telehealth is an efficient and convenient way to address health needs, manage chronic illnesses and gain insights into the home environment.”

According to Kripalani, telemedicine is a tool that could not only help primary care physicians provide cost-effective virtual care to patients and cut down on in-office visits and long patient wait times, but she contends that the technology has myriad benefits—including the potential for telehealth to effectively manage chronic diseases such as diabetes, hypertension and behavioral health.

“Advantages include the ability for medical personnel to thoroughly review medications—including over the counter medicines—that patients take at home, but frequently forget to bring to their doctor’s visits,” testified Kripalani. “Telehealth can enhance the patient history by allowing family members in the home to participate in the visit, when they may not have been able to attend a face-to-face visit. It allows the physician to gain insight into home conditions that may affect the safety or health of the patient.”

Kripalani noted that, in her state of Tennessee, telehealth visits are only covered by Medicare and Medicaid when patients come to rural healthcare clinics—but not from home. Likewise, while some commercial insurers will pay for telehealth if a patient presents to a remote healthcare site, she observed that payers will not reimburse for home telehealth.

“Imagine the time and cost saved for the patients and the system if the patient and physician could coordinate a time to ‘log-in’ and conduct a visit without the administrative burden, time, cost and inconvenience of an office visit,” added Kripalani. “Telehealth may also increase access to primary care and certain limited-supply resources such as mental health, dermatology and other subspecialties.”

“Why ask a family with a child with Down syndrome to drive a two-ton vehicle three hours from their rural home to a specialist in the city if they can FaceTime their physician from the comfort of their home?” said Josh Umbehr, MD, co-founder of AtlasMD Family Practice, in his testimony, adding that telemedicine will “further extend the reach of every physician in every specialty for every patient.”

Toward that end, Kripalani urged the Senate health committee to “support coverage of at-home tele-visits so that Tennesseans and all Medicare beneficiaries can more easily access the healthcare they need.”

Tracy Watts, senior partner and U.S. healthcare reform leader at consultancy Mercer, told lawmakers in her testimony that telehealth “has become the norm” in employers’ plans—with 80 percent of employers offering the technology. However, she observed that utilization rates are low.

In addition, Watts noted that consumer research recently conducted by Oliver Wyman found that just 10 percent of consumers have used telemedicine services in the past year.

For its part, Vanderbilt University Medical Center has initiated a home telehealth pilot for Vanderbilt-insured employees to evaluate the technology, according to Kripalani.


reprint