Medicare will start paying for telemedicine

Telemedicine has been around for a couple of decades. But using cameras to bridge distance between doctors and patients hasn't become quite as popular as early advocates envisioned.

Some rural hospitals use the video links to give patients easier access to specialists.

"I think states are going to have to move in the direction of much greater encouragement if not requiring more care be provided by telemedicine."

At Tri-County Hospital in Wadena a patient has his knee examined by an orthopedic specialist who's in the twin cities.

The physician is shown on a large video screen in front of the patient. A hand-held camera allows her to see the patient flex his knee while she talks to him.

The big benefit of telemedicine in this case is that the patient avoids a six-hour round trip to see the doctor.

Traveling to see the doctor can be even more difficult for frail, elderly nursing home patients. That's why in Wadena, some patients don't leave the nursing home when they have an appointment at Tri-County Hospital.

Hospital Telemedicine Manager Robin Klemek says they decided to monitor nursing home patients who have bedsores or other wounds by camera even though Medicare didn't fully reimburse for the care. She said that allows nursing home staff to talk directly to hospital staff, saves hospital staff the time spent traveling to the nursing home, and reduces the stress on, elderly patients who might otherwise need to be brought to the hospital for an exam.

"A lot of them were having to be brought in by stretcher and then they have to wait in the clinic for their appointment," explained Klemek. "It was just not a good situation, not a good way to provide patient care."

Not having to take a nursing home patient out into bitterly cold weather is an obvious benefit. But transporting those patients is also a big expense.

A study in Maine found an average savings of $580 for each nursing home patient seen with a telemedicine appointment.

There's not enough data to quantify how much money could be saved in Minnesota, according to University of Minnesota Professor Stuart Speedie, but he's looked at case studies where transportation added more than $1,000 to a patients doctor visit.

So it seems like an obvious place to save some health care dollars. But there's a catch.

Speedie points out that most nursing homes in Minnesota don't have the technology for telemedicine, and he doubts they will rush to buy that equipment.

"It will be a difficult decision for nursing homes to make to install this technology. Obviously nursing homes are not flush with cash to spend on such activities right now. They operate on a pretty thin margin as it is," said Speedie.

Practitioners say telemedicine equipment that cost $55,000 a decade ago can now be purchased for about $5,000.

Telemedicine savings would quickly pay for the cost of equipment, according to Stuart Speedie. But, most of those savings would go to Medicare or private insurers, not nursing homes.

The new federal rule allows nursing homes to charge a $20 facility fee for each patient using telemedicine. But they would need to spend several thousand dollars for cameras, monitors and secure broadband internet connections.

Stuart Speedie said potentially, state government stands to see the most savings. "I think given the current economic situation and looking for every possible method of saving money and knowing how the costs of healthcare are increasing dramatically, I think states are going to have to move in the direction of much greater encouragement if not requiring more care be provided by telemedicine," said Speedie.

Its unclear how many nursing homes might consider becoming a telemedicine site. The Minnesota Long Term Care Association which represents the states nursing homes, declined to discuss the new Medicare rules. "I think it will be significant, but it's all about endless possibilities," said Minnesota Telehealth Network Project Director Cindy Uselman. "I think it's about what makes sense and I think more people are going to join in on it. It's time for more people to get on board and I think the conditions are right."

Tri-County Hospital Telemedicine Manager Robin Klemek won't speculate on how the Medicare rule change might expand telemedicine. But based on her experience in Wadena, she knows the potential.

"We know the patients are going to benefit. We know the doctors are going to benefit because they won't have to leave their clinic to go out for the morning. I think it's going to help their productivity because they won't have that windshield time," said Klemek.

The new Medicare reimbursement rule takes effect in January.

The change also expands telemedicine coverage to community mental health centers and renal dialysis facilities.

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