A law that eases restrictions in the way telemedicine is delivered in Arkansas goes into effect in August and will help Arkansas hospitals expand their range of virtual services.
The law will allow patients to receive telemedicine services wherever they happen to be, rather than having to visit a health care facility.
Making the patient travel to a health care office was "a pretty onerous burden," said Adam Greathouse, a health policy expert at the ERISA Industry Committee of Washington, a national association that advocates for large employers on health policies. "That's like having to go to an internet cafe in order to check your email."
The Arkansas Legislature earlier this year amended the state's telemedicine law governing the way virtual care is delivered. Its rules had been considered among the most restrictive in the country.
Greathouse said the amendment is a positive step, but "there's always room for improvement."
Telemedicine is gaining momentum as a diagnostic and tracking tool for providers and especially patients, said Paul Cunningham, executive vice president of the Arkansas Hospital Association. "If they can see a doctor virtually from their home rather than driving 30, 40, 50 miles, [it's] certainly helpful there," he said.
The amended law also requires that, starting Jan. 1, health benefit plans reimburse for telemedicine services as if the patient were seen in person. The earlier version of the law required only that the telemedicine doctor would be paid.
"What's going to be good about this new law is it's going to allow people to actually practice using telemedicine where before it was pretty limited," said Shawn Harwell, director of telemedicine at Arkansas Children's Hospital. "The reimbursement mechanism really didn't encourage folks to want to, or be able to, provide care through telemedicine."
The Mercy hospitals in Fort Smith and in Rogers, which already offer some telemedicine services, are expanding their programs to bring virtual health care providers to a patient's home through an internet connection, a tablet and wireless monitoring equipment, such as a blood pressure cuff and a weight scale.
Another new service will be Mercy's TeleHospitalist, which will allow its medical staff at a remote location to do rounds in a Mercy hospital. It is touted as improving patient safety and allows for quick responses to a patient's needs.
Mercy spokeswoman Jennifer Cook told Arkansas Business in an email that Mercy didn't have a date for when the programs will be in place, but she expects it will be soon.
The virtual health care providers will work out of Mercy's $54 million virtual care center in Chesterfield, Missouri, which opened in 2015.
Arkansas' telemedicine law also now allows providers who are out of state to provide medical services as long as they are licensed to practice medicine in Arkansas. Cook said that Mercy's virtual care providers have applied to be licensed in Arkansas and that process is pending.
The virtual home service for patients has succeeded in other Mercy locations. About 500 patients have enrolled in the program, which has been in place for about two years, and nearly all of them said they were satisfied or extremely satisfied with it. The patients also experienced a 50 percent decrease in emergency room visits and hospital readmissions.
Encouraged by New Model
Telemedicine also is expected to grow in use as health care transitions from a fee-for-service model, where the provider gets paid for each service and which encourages volume, to a value-based model, which rewards health care workers for keeping the patient healthy, said Dr. Curtis Lowery, the director of the University of Arkansas for Medical Sciences Center for Distance Health.
UAMS has offered telemedicine services since 2003, and is looking to expand its programs to include monitoring patients rather than have them come to a doctor's office.
After a patient has a cesarean section, "does the patient really need to come all the way to Little Rock to be seen to look at their C-section scar?" he asked.
"We don't really do much of anything else besides that … so why couldn't we see their scar from their home with their smartphone?"
Arkansas Children's Hospital also is working on expanding its telemedicine services.
In early September, ACH will expand its asthma telemedicine program to its clinic in Texarkana, said ACH's Harwell.
"From there, we'll keep offering it around the state to other areas to help kids," he said.
The program allows children who have first been seen at the Little Rock hospital campus to have follow-ups at its Jonesboro clinic.
The number of ACH's patients who use the telemedicine services is "pretty low" at around 100 children a month, he said. But he expects that to change.
ACH's urology telemedicine program, which is operating at ACH's Lowell, Jonesboro and Texarkana clinics, has doubled its volumes in the last few months.
"We're seeing significant growth as the different programs get more and more established," Harwell said.
And in other states that enacted similar telemedicine legislation there was a "big boom in the volume and use of telemedicine in their states," he said.
The 25-bed Piggott Community Hospital has been using telemedicine services for several years and has partnerships with providers like UAMS and Baptist Health of Little Rock for telemedicine consultations. And its list of partnerships is growing.
Starting July 1, the Clay County hospital begins work with Mid-South Health Systems in Jonesboro for mental health consultations, said Piggott's executive director, James Magee.
Magee also wants to work with nursing homes in the area to offer telemedicine services in which the doctors would do rounds remotely.
"That would save the doc's time and probably be much more productive," Magee said. "So we're looking at those and other programs … as a way to expand our telemedicine."
Equipment to do that, though, costs around $300,000, he said. "There's a lot of application for telemedicine out there that hasn't been tapped," he said. "We just don't have any money in the cash register."
The telemedicine program started at the hospital thanks to a $110,000 grant awarded in 2014 from the Blue & You Foundation for a Healthier Arkansas, which was created by Arkansas Blue Cross & Blue Shield.
The equipment allows for a patient to come to the hospital and be taken to a room with the telemedicine equipment and a nurse. The virtual doctor and patient can see each other on a screen, and a nurse is in the room to use a stethoscope on the patient. "The technology is such that [the doctor] hears that heart as if the doctor is in the room," Magee said.
He said it is unclear how much telemedicine has saved the hospital. The service, however, has expanded access to specialty care in the rural area.
Piggott is about an hour's drive from the larger hospitals in Jonesboro. Having the telemedicine services at the hospital also provides convenience to patients.
Promoting telemedicine also promotes health care because it eliminates some of the barriers, such as needing to drive an hour to see a specialist, Magee said. "A lot of times those speciality visits don't get made," he said. "And then the condition worsens."
ACH's Harwell said he doesn't think telemedicine will ever replace the need for a doctor to see the patient in person. "But it can certainly take the place of extra trips," he said.