Worried about 'defensive medicine' in telehealth? Go on the offensive

From left to right: Joel E. Barthelemy, Shannon Murphy, David Cattell-Gordon and Mark Liber
From left to right: Joel E. Barthelemy, founder and chief executive officer of GlobalMed; Shannon Murphy, director of federal health solutions at Microsoft; David Catell-Gordon, MSW, director of telemedicine at the Karen S. Rheuban Center for Telehealth in the UVA Health System; Mark Liber, academy manager at StartUp Health.

WASHINGTON—Despite substantial industry excitement around telehealth as a way to coordinate care and improve outcomes, there is still some lingering concern that virtual care could lead to defensive medicine.

Defensive medicine has its roots in medical malpractice, with physicians ordering unnecessary tests to limit their liability. For telehealth, concerns revolve more around the limitations of virtual care: If a doctor is limited to calling or even video-calling a patient, they may lack many of the diagnostic tools they need to determine whether a test is necessary. To play it safe, they'll call for the test.

But a panel of experts at an event hosted by the Connected Health Initiative at the Microsoft Innovation & Policy Center on Tuesday said those costs can be mitigated through improved remote diagnostics and better planning on providers' part. Moreover, given sufficient coordination, telehealth applications can end up cutting costs and providing hospitals with a new, profitable service line.


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For example, rather than paying a pediatric endocrinologist to travel to a small rural hospital three days a week, hospitals can access that provider virtually and only pay for their time with patients, said Shannon Murphy, director of federal health solutions at Microsoft, outlining an approach she called "going on the offensive."

"Therefore, I'm only paying them when I'm making money," she said. "So now if you stop to think about this as offense, not defense—that's where rural health systems are struggling to make money because they're not offering enough services." 

RELATED: Defensive medicine may curb malpractice claims, study finds

Integrating digital tools can help. While telestroke programs have been lauded for their ability to evaluate patients and prescribe life-saving drugs quickly, providers are limited in the information they have at their fingertips. If a neurologist is unable to physically examine a patient at risk for a stroke—even one at very low risk—they are much more likely to order an MRI, resulting in thousands of dollars in potentially unnecessary imaging.

"For that stroke patient, being able to see that patient right away, being able to actually interact with them—especially on an ischemic stroke—it's paramount for you to have the connectivity and for you to have the evidence," said Joel E. Barthelemy, founder and chief executive officer of GlobalMed. "Because you can't even go through your stroke scale to make sure that patient is having one kind of stroke versus another."

To make up for that in-person gap, most panelists expressed how it important it was for physicians on the other end of the line to have the maximum information possible when evaluating a patient. David Catell-Gordon, director of telemedicine at the Karen S. Rheuban Center for Telehealth in the UVA Health System, said the answer is in getting diagnostic tools into the hands of patients and then getting that data transmitted to doctors.

It's important "being able to see the patient, see the images; having diagnostic peripherals in the home that provide this kind of information, because I don't believe you can prescribe antibiotics this way," Catell-Gordon said, holding a cellphone to his ear. "You have to have the full field of information, and telehealth—when we provide it correctly—is providing that."

Beyond mitigating the extra costs of defensive medicine, panelists asserted that there were myriad other ways to save costs through telehealth applications. For instance, rural hospitals, which have run into a range of funding problems recently, have found ways to make money off telehealth because it enables them to keep patients in those hospitals.

RELATED: A third of rural hospitals at risk for closure; extension of federal programs could provide relief

Barthelemy offered a case study of a rural hospital in Arizona that previously had a policy that cost them a lot of money: Whenever a patient presented with potential heart attack symptoms, they immediately airlifted that patient to Tucson—the emergency physicians on site didn't want to take chances.

After implementing a telehealth initiative at that hospital, however, local physicians were able to consult with cardiologists around the country and better determine when a case truly required the patient to be moved. As a result, the health system was able to save hundreds of thousands of dollars in transfers in the first year, and moreover, the hospital started making more money because it was treating the patients it was no longer transferring.

"We have too many unnecessary transfers in our health system nationally, and telehealth creates a link to specialty practice and consults," Catell-Gordon agreed.

"Telemedicine's not just defensive medicine," added Murphy.

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