Broadband expansion is crucial to health care access

September 16, 2019 12:01 am

The hamlet of Head Waters in Highland County was rated between “unserved” and “underserved” for high-speed internet access in 2018. (Ned Oliver/Virginia Mercury)

By Karen S. Rheuban, M.D.

Remote patient monitoring may not ring a bell to most but, then again, neither did the term MRI before the mid-1990s.

Much like the groundbreaking impact that medical-imaging technologies such as MRI and CT scans have had on patient diagnostics, RPM has the potential to revolutionize care and transform the patient experience. If trends continue and as telemedicine and remote patient monitoring become more widely adopted, we predict a transformation in patient engagement, patient outcomes and a significant reduction in health care costs.

An umbrella term that incorporates a broad range of patient-generated technologies and clinical applications, remote patient monitoring is a subset of telehealth through which patients can digitally monitor a variety of conditions and vital signs at home, at work or anywhere outside bricks and mortar healthcare facilities. Patients’ information is transmitted and analyzed by their physician or nurse practitioner, who can quickly intervene if something is out of range. In short, remote monitoring brings care to the patient instead of the patient to care.

Health care costs have skyrocketed over the past two decades. Patients residing in the most rural and/or underserved communities who experience limitations in access to care – such as disabled or elderly patients, or rural patients with chronic illness – are often those who have suffered the most from the increasing financial burden of access to care. Sadly, it is all too common to see patients ignore or underutilize treatments simply because it costs too much.

Remote monitoring programs have been shown to improve patient outcomes and lower the cost of care by reducing hospital length of stay, preventing ER visits and hospitalizations. Shorter hospital stays and fewer doctor visits result in lower overall health care costs and out-of-pocket costs for patients. Patients and family members also avoid taking sick days from work and the expense of transportation to a health care provider.

The University of Virginia Health System has long recognized the challenges faced by our rural patients and have embraced the transformational role of telehealth.

Established in 1995, the UVA Center for Telehealth has supported more than 100,000 patient encounters and saved citizens of the commonwealth more than 20 million miles of driving to access care.   Currently, the UVA telehealth program connects our doctors and nurses with patients at more than 150 facilities across the commonwealth, spanning more than 60 different clinical subspecialties. These specialties range from prenatal services, to emergency and acute care consultations, and follow up visits.  We also provide RPM services.

Examples of our RPM programs include Imprint, a partnership through which we discharge stable premature infants home from the hospital with video and vital sign monitoring, all the while keeping those infants connected virtually to our neonatal intensive care specialists and team. The outcomes of the program thus far have been extraordinary. Length of stay in the Newborn Intensive Care Unit has been shortened, family satisfaction rates are sky-high, and the infants have demonstrated improved health outcomes.

Another example is a diabetes remote patient monitoring program developed in partnership with Tri Area Health, a community health center in Carroll County.  Since the program’s launch earlier this year, participating patients have demonstrated a significant reduction in Hemoglobin A1c levels, a marker for diabetes complications such as heart disease, kidney failure, blindness and vascular disease. Not only have health outcomes improved and costs been lowered, but patient engagement in the program is highly enthusiastic.

These are just two of a multitude of clinical opportunities available to patients facilitated by remote monitoring. However, access to these services is very much dependent on access to broadband, or high speed internet. For an estimated 660,000 unconnected Virginians, remote patient monitoring is simply not an option. Not surprisingly, those same unconnected communities report some of the worst health outcomes in the commonwealth.

Telehealth has also become accepted by commercial health plans, thanks to legislation passed by the General Assembly. Medicaid covers a broad range of telehealth services, and we hope to continue expanding remote patient monitoring for our most vulnerable populations. In 2019, Medicare announced coverage of remote patient monitoring programs.  The Veterans Health Administration has broadly adopted telehealth and remote patient monitoring  programs as well.

The Federal Communications Commission recently announced its intent to establish a $100 million connected care pilot program aimed at increasing access to care for low-income rural patients and veterans. FCC Commissioner Brendan Carr chose to make that announcement in June at the Tri Area Health clinic in Carroll County.

Exciting developments in telehealth are happening in Virginia and beyond,  but state and federal leaders must continue to increase public investment in broadband and telemedicine services.

Former Vice President Hubert Humphrey once said that “the moral test of government is how that government treats those who are in the dawn of life, the children; those who are in the twilight of life, the elderly; those who are in the shadows of life, the sick, the needy and the handicapped.” The Commonwealth of Virginia and her citizens have a duty to bridge the digital divide and provide equal opportunity to all patients in all communities, regardless of zip-code. We can, and must, do better.

Dr. Karen S. Rheuban is a professor of pediatrics and director of the University of Virginia Center for Telehealth.

Disclosure: Dr. Rheuban reports service on the Advisory Board of Tytocare LLC,  the boards of Locus Health, the Medical Society of Virginia, the Virginia Telehealth Network and the Virginia Board of Medical Assistance Services. Dr. Rheuban reports no financial interest in Locus Health in which the University of Virginia holds a minority ownership interest.

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