Published On Sep 12, 2016
Death and Distance
Telehealth programs are changing how people get better—and sometimes the way they die.
When Proto last looked at the state of telehealth—the digital delivery of medical services over distance—the practice was already moving from the fringe to the mainstream (“(Out of) Office Visit,” Fall 2014). A recent industry report confirmed this growth, showing that 72% of U.S. hospitals now use telehealth services, up from 52% just two years before.
One of the technology’s more surprising applications has been in palliative care, a specialty that aims to relieve the suffering that accompanies serious illness, sometimes at the end of life. Palliative care is famously “high touch,” since it focuses on the physical and emotional well-being of patients and their families. But some practitioners are finding that digital care can give that same touch in ways that are less disruptive to those in a critical stage of life.
ProHEALTH Care Associates, a large physician group practice in the New York metropolitan area, runs such a palliative care program. In 2015, the group began conducting virtual house calls with about 100 patients using smartphones, according to Dana Lustbader, a physician and chair of ProHEALTH’s palliative care department. “I can examine a patient remotely, provide medical guidance and do a follow-up visit four hours later, if needed,” she says.
That allows Lustbader’s patients to stay at home, which is where the majority of people prefer to spend their time at the end of life. “Telehealth also decreases unnecessary emergency room visits or hospitalizations, which put these patients at a higher risk of complications,” she says. Smartphones also allow her to loop in family caregivers more, and help her communicate with them about end-of-life preferences.
The technology is especially useful when patients live far from their physicians. University of Kansas Medical Center has partnered with Hospice Services & Palliative Care of Northwest Kansas, which delivers care to patients in 16 rural counties in the state. With its pilot telehealth program, a nurse can visit homebound patients and link physicians and out-of-town family into a teleconference using a tablet computer. And those patients can use their own devices to access hospice care 24/7, says Sandy Kuhlman, the executive director of Hospice Services.
Such calls get a much quicker response in the wee hours, says Kuhlman, as a patient can be immediately evaluated through a videoconference rather than wait for a nurse to drive three hours to conduct a home visit. As part of the pilot, Hospice Services will collect data over the next three years on this approach.
Economics could decide whether these programs become more widely adopted. For example, they may offer a cost-effective way to manage health crises late in life, when medical bills are highest. Lustbader says that the ProHEALTH program has already helped keep patients from having to return to the hospital after being discharged. But telehealth visits to patients at home aren’t reimbursed by most insurers, including Medicare and Medicaid.
That may change. Congressional lawmakers are considering proposals that would allow Medicare coverage for some telehealth services for the chronically ill who are homebound, including hospice patients. That could be a game changer, says Gary Capistrant, chief policy officer at the American Telemedicine Association. “Health care delivery is driven by what is and isn’t reimbursed,” he says. “If Medicare leads a breakthrough, private payers could follow.”