Telestroke and telemental health have led the way in the use of technology to expand access to specialists beyond the physical boundaries of one office. Telestroke practices deliver specialty care within the time that treatment of stroke can be most beneficial to a patient. The benefits and savings downstream for a stroke patient can be enormous when you consider the patients independence preserved by timely care and the costs involving a skilled nursing facility for when it isnt. Telemental health only requires videoconferencing to make regular visits convenient for both providers and patients. The return on investment in these two areas of clinical telemedicine is accepted and fairly well defined because of the narrow scope of the healthcare delivered remotely.

Telemedicine can decrease no show rate by reducing inconvenience of long commute to physician offices What may be less clear for providers and healthcare facilities is the ROI for other specialties, like cardiology. Most cardiologists may be surprised to learn that they are underutilizing technology, that their programs could be more fully functional and reap more reimbursements. Perhaps, the main office is located in an urban area where traffic is consistently heavy or patients must use public transportation. The rate of medical appointment no-shows on average ranges between 7-15% nationally and may be as high as 30%, primarily because of inconvenience. The Center for Health Affairs reported that missed medical appointments cost providers $150 billion in 2013.

Consider a practice that uses telemedicine technology to assess patients at a satellite office. Unless the team at the main office is transitioning more care to the remote office, the practice cannot easily expand and generate more income. Physicians who have a full schedule of in-office and remote patients may be reluctant to add more live, virtual consults. A recent article in the Annals of Internal Medicine found that specialists spend twice as much time documenting a patient visit in their electronic health records and on other administrative duties than they spend with the patient.

Using the Cloud to expand healthcare access However, patient visit to a satellite office doesnt always require a live consult with a cardiologist. For example, a mid-level provider can administer an ECG for an established patient who is in for a routine exam and be reimbursed for the patient visit. The test strip can be recorded and saved in the patients electronic medical record in the facilitys PACS server or in a cloud server. This allows the specialist to sign-on to the system at a later time, review the ECG, and enter a note in the record. These ancillary tests provide revenue without adding patients to an already busy schedule.

The national average reimbursement for an Examination and Maintenance visit (CPT 99213) for an established Medicare patient is $72; for a new patient (CPT 99203), its $108. The reimbursement for spending a few minutes interpreting a test strip is about $17. Just five extra patients a week can mean added billing of between $450 and $625. Moreover, this is just one of many connected medical devices that could be used at the remote office. Others peripherals include: vitals, digital stethoscope, ultrasound, examination camera (for ear, nose, throat), dermoscope, ophthalmoscope, EEG, X Ray.

According to the National Health Council, ongoing and chronic disease affect approximately 133 million Americans, representing 40% of the total population. Telemedicine can be a major component in improve the continuity of care for these patients, it can give providers a more efficient way to monitor patient compliance and improve outcomes, as the United States shifts towards a value based care model.

The idea is a simple one. Convert these non-telemedicine encounters into telemedicine encounters when necessary. The advantages include: a decrease in patient wait time for an appointment, fewer appointment no-shows, convenience for patients that raises satisfaction rates, and a potential decrease in hospital readmissions with access to more timely care.

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