A Recent Study on the Adoption of Telemedicine Reveals Who Runs the Show in Healthcare
Just yesterday, a study was published in Telemedicine and E-Health that featured the findings of the Mayo Clinic in Arizona, C3O Medical Group in Ojai, CA and UCLA Medical Center in West Los Angeles. They asked what is helping and impeding the use of robotic telemedicine in emergency and critical care applications in these institutions. They found that “Administrative Burdens” and “limits on reimbursement” are the primary culprits impeding the use of telemedicine.
The sad thing is, the authors are not shocked. Noted as the biggest issues are:
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- Licensing restrictions
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- Admin burden of giving physicians credentials and privileges to practice telemedicine and make sure malpractice insurance is in place
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- Limitations in billing and reimbursement.
No one is surprised because the practitioners of healthcare in the US are not in charge. Neither are the providers of technology that enable them. Our US healthcare system is now run by an “Administrative Financial Complex” (compare to the Military Industrial Complex of Ike Eisenhower and Oliver Stone fame) which has now become self-aware like SkyNet in the Terminator movies and is now nearly solely focused on insuring its own survival and growth. We collectively marvel at how our health insurance rates continue to rise meteorically, while healthcare practitioners, institutions and and consumers keep getting squeezed.
The Great Sucking Sound You Hear is Administration Vacuuming Healthcare Dollars
In 1992, Ross Perot talked about the “great sucking sound” of jobs being drawn overseas for cheap labor. Today the great sucking sound is generated by the healthcare insurers, the Administrative Financial Complex which is charged with topline growth by Wall Street, and whose growth comes at the expense of our US healthcare system. While you can argue whether the sound levels are increasing or decreasing, they are way too much for our system to handle, and something HAS to change. Either something will change or it will break. And we really don’t want it to break.
Health insurers are necessary and are an important part of the checks and balances that are built into a managed care methodology for making decisions on healthcare. However, it should not have the power it has, primarily because it is not first interested in better more affordable care; it is interested in growth.
Not Many Answers Here, Which is the Big Problem
This is however, not a problem easily solved. Charging the Government with this responsibility is not going to make things better, absolutely for sure. Conservative political forces have no interest in non-market based solutions, which is smart, but not going to enable limits on topline revenue insurer growth. Liberal political forces have little credibility with the private sector, and have a poor rapport with healthcare providers as well.
Somehow, we have to find a way for those who invest in healthcare insurers to receive gains when company leaders reduce the size of their companies, reduce the amount of raw dollars that flow into them from premiums and create new efficiencies in the US healthcare system. This is not impossible, but will require the ourage to to do battle with some of Washington’s most powerful lobbies, the will to espouse politically dangerous ideas such as being against the growth of healthcare insurers and numbers and estimates to persuade. Who has the most to gain from doing this?
The answer is the healthcare provider community coupled with the providers of tools and technology enablement; they together stand to gain the most from a new schema and likely have their own lobby as well. A well-conceived effort to craft a way for a special class of organizations to trade on their cost containment and efficiency achievements to be qualified, along with a commitment to sensible limits (higher than CMS guidelines but sensible just the same) on the cost of care and some financial modeling would be a great place to begin the debate. Given something that really makes sense, the more results oriented members of our government would take it from there.
One Last Thing…
Harkening back to the article that began the conversation, a significant factor in the stunted use of telemedicine is the fear of litigation, or the risk-reward equation. It is out of balance and must be corrected. This means that we also have to simultaneously pass tort reform as well. That has proven to be a tough nut to crack, but with the combined juggernaut of the above proposal, maybe now is the time to roll the whole thing through the process. It may just be the most important thing we do for our future.
