Is Pennsylvania Ready For Telemedicine Expansion?

Recent Report Card, Poll suggests barriers stalling progress

May 04, 2015, 08:05 ET from Pennsylvania Medical Society

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HARRISBURG, Pa., May 4, 2015 /PRNewswire-USNewswire/ -- While national trends are pushing adoption of telemedicine across the country and patient demand is growing, barriers including lack of standards of care, insurance payment, and patient trust levels may be slowing progress in Pennsylvania.

"Pennsylvania has the technology and the clinical expertise to be a leader in telemedicine," says Karen Rizzo MD, president of the Pennsylvania Medical Society (PAMED) and a practicing otolaryngologist (ENT) from Lancaster. "We just don't have the right state insurance laws and the public just hasn't had a chance to experience it. We need to do a better job of educating politicians and the public."

Telemedicine, according to Dennis Olmstead, chief strategy officer & medical economist at PAMED, as it pertains to the delivery of health care services, means the practice, by a duly licensed physician or other health care provider acting within the scope of such provider's practice, of health delivery, diagnosis, consultation, treatment, or transfer of medical data by means of audio, video, or data communications which are used during a medical visit with a patient.

Technology often used in telemedicine includes two-way video, wearable devices, smart phones, and wireless tools. It can be used for specialist referral services and consultations, remote patient monitoring, and consumer health education.

"The full use of telemedicine is part of the answer to helping thousands of Pennsylvanians living in areas of the state that are considered medically underserved," says G. Alan Yeasted, M.D., FACP, president of the Pennsylvania Chapter of the American College of Physicians and a practicing internal medicine specialist in Pittsburgh. "But as we can see from the September 2014 American Telemedicine Association report card and the March 2015 Pennsylvania Patient Poll, we have plenty of work to get done here."

The most glaring problem for Pennsylvania identified in an American Telemedicine Association report card deals with private health insurance for which the state received an "F." Pennsylvania has no telemedicine parity law. In other words, insurance companies do not treat telemedicine as an equal service to in-person services. Specifically, insurance coverage for telemedicine services is not available or barely exists, and thus discourages providers and patients from using the technology.

Not helping matters are the grades for parity that Medicaid and the State Employee Health Plan received - C and F respectively.

"When you think of a rural community that lacks specialties like psychiatry, dermatology, and cardiology, the use of telemedicine could be quite valuable," says Robert Elden Wilson, MD, PhD, of the Pennsylvania Psychiatric Society. "But since telemedicine isn't treatedthe same as an in-person physician visit from an insurance perspective, there's little coverage and patients could face out-of-pocket expenses which may not be affordable."

However, Dr. Wilson, a child and adolescent psychiatrist practicing in Erie, adds that telepsychiatry - telemedicine specific for psychiatry - is beginning to be used to provide psychiatric management in rural parts of the state where it is difficult to secure adequate in-person psychiatric time. "While some patients were somewhat skeptical at first, they generally found the interaction with the telepsychiatrist beneficial and their comfort level with the process quickly increased" Dr. Wilson says. "Treatment results have been as good as traditionally delivered care."

But, overall public understanding of telemedicine is a factor that could also be slowing down telemedicine adoption in Pennsylvania.

The Pennsylvania Patient Poll, conducted March 6 through 12 by Susquehanna Polling and commissioned by PAMED suggests that patients view in-person appointments with physicians as more important than using telecommunications opportunities. When asked how important it is to see a doctor in person as opposed to seeing a doctor through telemedicine, Pennsylvanians overwhelmingly say in-person meetings are either very important or somewhat important. Only six percent indicated they are not important.

But, 50 percent indicated that they would use videoconferencing from the comfort of their home to see a doctor, and 49 percent said they would trust a diagnosis delivered by video conferencing. These statistics suggest that about half of Pennsylvanians are willing to try it. In addition 58 percent say they likely would use email or the Internet to consult with their physician.

"Once Pennsylvanian's have a chance to experience telemedicine and understand its value, I imagine more would be willing to use telemedicine as the word spreads," says PAMED's Dr. Rizzo. "Barriers like insurance coverage are holding up opportunities for Pennsylvania patients to fully engage and experience telemedicine."

This is unfortunate, says Srinivas Murali, MD, FACC, president of the Pennsylvania Chapter of the American College of Cardiology. Already, he says there are nearly 1 million Americans currently using remote cardiac monitors, and nationally there are about 200 telemedicine networks and 3,500 service sites assisting patients with numerous health conditions including chronic diseases.

"There's plenty of peer-reviewed research that shows the cost effectiveness of telemedicine in addition to scientific studies indicating the use of telemedicine has resulted in improved care," says Dr. Murali, who practices in Pittsburgh. "Pennsylvanians particularly those with chronic diseases would benefit from increased use of telemedicine, but first state insurance laws need to be changed to give residents and health care teams a chance to try it."

According to PAMED's Olmstead, a telehealth task force, consisting of a variety of medical specialists from throughout the state, has been convened by the medical society to push for standards in licensure, telemedicine practice principles, and payment parity in the Keystone State.

Chairing the task force is Marilyn Heine, MD, a hematology oncology specialist from Bucks County and a past president of the organization.

"There's interest among Pennsylvania physicians to advance telemedicine use in our state in ways to best serve out patients," says Dr. Heine, who represents the Pennsylvania Society of Oncology and Hematology on the task force. "Legislatively, laws need to be updated so that our residents can safely enjoy the benefits of this technology like patients in many other states."

The Pennsylvania Patient Poll Statewide Attitude Survey Conducted March 6-12, 2015

Q: How important is it to see your doctor in person or in a face-to-face setting, as opposed to seeing your doctor other ways like with the use of video features or telephone - very important, somewhat important, or not at all important?

1.Very Important 63%2. Somewhat Important 31% Total Important 94%3.Not at all important 06%4.Undecided 00%

Q: If you had the ability to see and talk to your doctor from the comfort of your home with the use of new video conferencing features, would you use this option if it meant you didn't have to travel to your doctor's office every time?

1.Yes 50% 2.No 47% 3.Undecided 02%

Q: How likely would you be to consult with your doctor using the internet or email instead of going to their office if you had that option - very likely, somewhat likely, or not at all likely?

1.Very likely 26% 2.Somewhat likely 32% Total Likely 58% 3.Not at all likely 41% 4. Undecided 00%

Q: Would you trust a diagnosis delivered by way of video conference with your physician?

1.Yes 49% 2.No 43% 3.Undecided 07% 4.Refuse 01%

Survey Demographics

Gender Male 50% Female 50%
Age 21 to 25 10%
26 to 34 16%
35 to 44 14%
45 to 54 19%
55 to 64 19%
65 and older 22%

Party Affiliation
Republican 40%
Democrat 48%
Independent/Other 12%

Health Insurance Status
Yes 97%
No 02%
Refuse 01%

Which of the following statements best describes your current health?
52% I consider myself to be a very healthy person, and/or see the doctor only on a limited basis
34% I consider myself to be a fairly healthy person, but have medical
conditions that require on-going treatments or care
12% I am someone who has one or more serious health-related issues or medical conditions that require constant medical treatments, procedures or surgeries
02% Refuse

Main racial heritage
White 78%
Non-white 20%
Refuse 02%

Areas breaks (from record)
03% Northwest [Erie, Crawford, Mercer, Venango, Warren, Forest]
11% Southwest [Lawrence, Beaver, Washington, Greene, Fayette, Westmoreland, Indiana, Armstrong, Butler]
10% The "T"/Central [Jefferson, Elk, McKean, Cameron, Clarion, Clearfield, Centre, Cambria, Somerset, Bedford, Fulton, Franklin, Huntingdon, Blair, Potter, Tioga, Bradford, Susquehanna, Wyoming, Sullivan, Lycoming, Clinton, Union, Snyder, Northumberland, Montour, Columbia, Mifflin, Juniata]
13% Northeast/Lehigh Valley [Luzerne, Carbon, Monroe, Schuylkill, Lackawanna, Lehigh, Northampton, Pike, Wayne]
16% South Central [Perry, Cumberland, Adams, York, Lancaster, Lebanon, Dauphin, Berks]
20% Southeast [Chester, Delaware, Montgomery, Bucks]
11% Allegheny County
15% Philadelphia

Data collection mode
Live Agent Interviews 39%
Automated/IVR Interviews 61%
Methodology: This poll was commissioned by the Pennsylvania Medical
Society and conducted by Susquehanna Polling and Research. Completed interviews were conducted March 6-12, 2015 with 700 Pennsylvania residents. In order to be eligible to complete the survey, respondents had to confirm they are a resident of Pennsylvania at least 21 years of age or older.

Interviews are conducted with respondents who use a landline telephone as their primary means of contact through our IVR/automated polling software, in which survey respondents score their answers to a pre-recorded set of questions using their telephone key pads. An augmentation of live agent interviews is simultaneously conducted with harder-to-reach segments of the population (e.g., younger age groups, households using cellular telephone exchanges as their primary means of contact, etc.) using the professionally-trained survey research staff from SP&R's main telephone call center. Results to both live agent interviews and automated/IVR surveys are then combined into a single data set. Surveys are carefully monitored to ensure a representative sample of Pennsylvania's population is achieved based on geography, age, gender and other demographics; results are sometimes statistically weighted.

The margin of error for a sample size of 700 interviews is +/- 3.7% at the 95% confidence level.

This news release is brought to you by the Pennsylvania Health News Service Project, consisting of 20 Pennsylvania-based medical and specialty associations and societies. Members of PHNS include Pennsylvania Allergy & Asthma Association, Pennsylvania Dental Association, Pennsylvania Academy of Dermatology & Dermatologic Surgery, Pennsylvania Academy of Ophthalmology, Pennsylvania Academy of Otolaryngology, Pennsylvania American Congress of Obstetricians and Gynecologists, Pennsylvania Chapter of the American College of Cardiology, Pennsylvania Chapter of the American College of Emergency Physicians, Pennsylvania Chapter of the American College of Physicians, Pennsylvania Chapter of the American Academy of Pediatrics, Pennsylvania Medical Society Alliance, Pennsylvania Medical Society, Pennsylvania Neurosurgical Society, Pennsylvania Orthopaedic Society, Pennsylvania Psychiatric Society, Pennsylvania Society of Anesthesiologists, Pennsylvania Society of Gastroenterology, Pennsylvania Society of Oncology & Hematology, Robert H. Ivy Society of Plastic Surgeons, and Urological Association of Pennsylvania. Inquiries about PHNS can be directed to Chuck Moran via the Pennsylvania Medical Society at (717) 558-7820,, or via Twitter @ChuckMoran7.

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SOURCE Pennsylvania Medical Society