Guest Column | October 13, 2017

Trump's Proposed Medicaid Cuts To Worsen Chasm In Care Access: Telehealth Can Bridge The Gap

Telehealth Care

By Kathleen Myers, MD, FACEP, and CMIO, AristaMD

While health policy decisions seem to be routinely made at the federal level without regard to their impact on patient care or population health, payers and providers don’t have that luxury.

Underscoring that point, the proposed $800+ million federal budgets cuts to Medicaid from the House and a similar proposal from the Senate would cut Medicaid funding deeply – and leave payers and providers little choice but to seek creative ways to achieve the always-elusive goals of improving the U.S. healthcare system: better quality care, lower costs and greater access to care for all patients.

Few recent innovations hold the potential to fulfill those crucial objectives for the nation’s most vulnerable populations – which include the poor, elderly, rural and those suffering from chronic conditions – like telehealth, also broadly known as telemedicine.

Among the most promising innovations in telehealth are physician-to-physician electronic consultations (eConsults) - defined as asynchronous, consultative communications within a secure, web-based platform in which physicians share a variety of materials, such as medical records, scans, x-rays and notes. Physician-to-specialist eConsults have proven particularly effective at increasing access to specialty care among underserved populations, which frequently have considerable difficulty in obtaining specialty care.

Barriers To Specialty Care Access
The barriers Medicaid patients face in accessing specialty care are significant and wide-ranging. Because Medicaid offers lower reimbursement than private payers, few specialists accept Medicaid patients, and those who do often limit the number that they’ll accept. Even when they’re fortunate enough to arrange an appointment with a specialist, many Medicaid patients often face obstacles in affording or organizing transportation and childcare. The result is long wait times for appointments, reduced access to care and deteriorating health for Medicaid patients unable to get the specialty care they need, according to the Center for Studying Health System Change.

Clearly, there exists a major need to enhance specialty care access for the Medicaid population, but given potential budget cuts, even less resources will be allocated to achieve that goal. It thus becomes even more crucial that we leverage telehealth, in general, and eConsults between primary care physicians (PCPs) and specialists, specifically, as a means of connecting underserved populations to specialty care from which they would not otherwise be able to benefit.

Through eConsults, Medicaid patients can experience a higher quality of care by extending the capabilities and efficiencies of PCPs, who see the broadest swath of patients. Additionally, eConsults help PCPs to deliver that much-needed expanded care in a cost-effective, efficient and timely manner, all within the comfort, security and convenience of the PCP’s own office, heightening patient satisfaction.

eConsults also have demonstrated the ability to reduce costs by eliminating the need for many in-person referral visits, and by decreasing emergency room visits as a result of early diagnosis and treatment of patients who likely would have gone untreated. A 2016 study in The Annals of Family Medicine found that 69 percent of eConsults were resolved without a visit to a specialist, and that the group of patients who participated in eConsults had fewer subsequent emergency room visits than patients who didn’t.

A Preview Of What’s To Come
The difficulty that underserved populations face in accessing specialty care today may be a preview of challenges facing all patients tomorrow, as specialists find themselves stretched increasingly thin.

By 2025, the U.S. is predicted to suffer from a specialist shortage of between 28,000 and 64,000, according to the Association of American Medical Colleges. Further, the specialist shortage is occurring amidst a backdrop of skyrocketing referral rates: Between 1999 and 2009, the probability that an ambulatory visit to a physician resulted in a referral to another physician rose from 4.8 percent to 9.3 percent, representing a 92 percent jump, according to a study in the Archives of Internal Medicine.

That’s why it’s critical that we further drive adoption of telehealth and eConsults in order to improve the cost, access, quality and efficiency issues faced by the U.S. healthcare system – whether budget cuts happen or not. These fundamental challenges facing the healthcare industry aren’t going away – so why wait? We have the opportunity to proactively address those gaps by leveraging intelligent technology to bridge the chasm of care – and optimize patient outcomes and population health for generations to come.