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ACP 2019: Internist use of telehealth on the rise


Policy changes, physician adoption of telehealth technologies to help advance patient care options, survey reports

Telehealth is on the rise with internists

More than half of internal medicine physicians (and subspecialists) are working in practices that implemented telehealth, according to new survey results from the American College of Physicians (ACP).

The survey of ACP members, released at its Internal Medicine Meeting 2019 on April 11 in Philadelphia, showed that 51 percent have adopted at least one of these telehealth services:
• e-consults (33 percent implemented, 10 percent considering)
• remote care management/coaching (24 percent implemented, 11 percent considering)
• video visits (18 percent implemented, 17 percent considering)
• remote patient monitoring (14 percent implemented, 11 percent considering)
• integration of data from patient wearables (9 percent implemented, 9 percent considering)

The survey, ACP reports, sought to better understand adoption of telehealth services by its members. ACP sampled 1,449 members in October 2018 and January 2019. Completed responses were received from 233 members (16 percent response rate). Of the respondent base, 72 percent were general internal medicine specialists and 28 percent subspecialists. All of the respondents were providing outpatient care.

Other notable findings:
• About 63 percent of those respondents with e-consult technology use it every week
• Having the technology does not equate to adoption and usage of telehealth services, the survey reports. Among those with the technology, only 19 percent use video visits every week, while 50 percent use remote care management every week.
• Physician respondents were typically not making decisions to implement the technology
• Many physicians are interested in learning more about available technology solutions (55 percent of those with no technologies implemented, and 51 percent of those with some implementations)
Barriers to adoption:
• 42 percent: Challenging to integrate virtual care into practice workflow
• 36 percent: Patients do have access to the technology to support virtual care
• 29 percent: Concern about potential medical errors
• 23 percent: Security and privacy of patient information
• 18 percent: No barriers identified
Reimbursement, licensing, and regulatory issues were also recognized as barriers to telehealth applications.

Andrew Dunn, MD, FACP, chief, Division of Hospital Medicine of Mount Sanai Health System in Montebello, N.Y. and incoming chair of ACP, explains, “As telehealth payment and regulatory burdens are removed, physicians are more likely to use these services for the care of their patients. ACP believes very strongly that telehealth can be a valuable tool to improve access, quality, and decrease cost especially in used in the context of a valid physician-patient relationship.”

Dunn cited recent policy changes that will facilitate adoption of telehealth applications, including:

• Medicare’s new payment codes for virtual check-ins, e-consults, and remote evaluation of patient images

• The Centers for Medicare and Medicaid Services (CMS) plan (slated for July) to remove the geographical requirements for the originating site of care (e.g. not limiting the use of telehealth to rural settings)

• CMS will add a patient’s home as the originating site for services for treatment of substance abuse disorders or mental health disorders

• Easing of geographic restrictions in the patient setting for conditions like stroke, home dialysis for end-stage renal disease

• On April 5, CMS eliminated geographic restrictions on telehealth services for patients with Medicare Advantage (slated to take effect in 2020)

The results of the survey underscored the need for additional physician resources, ACP notes, and the college is developing practical resources for members covering virtual visits, including appropriate use cases, practice workflow changes, the current state of reimbursement and regulation, and equipment and vendor selection. Other telehealth applications will be explored as telehealth technology matures.

"We hope these resources can help close the gap between physician use of telehealth and patients' desire for flexibility and access to their physicians," explains Tabassum Salam, MD, FACP, ACP's vice president for medical education.

In a prepared statement, the college states: “ACP supports the expanded role of telemedicine in the primary care setting when used as a component of a patient's longitudinal care, but recommends that physicians should use their professional judgement about whether the use of telemedicine is appropriate for a patient and the situation. ACP also supports reimbursement for appropriately structured telemedicine communications.” A 2015 ACP policy paper on the use of telemedicine in primary care offers additional information the subject. 

"ACP recognizes that telehealth technologies have the potential to improve access for patients, enhance patient-physician collaboration, improve health outcomes, increase patient satisfaction, and reduce medical costs," adds ACP President Ana María López, MD, MPH, MACP, in a prepared statement.

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