1st of 2 parts
By JIM STOMMEN
MDD Contributing Writer
Jon Linkous is CEO of the American Telemedicine Association (ATA; Washington), which bills itself as the largest membership-based organization in the world focusing exclusively on providing health and medical care through telecommunications technology. He has spoken and written extensively in the U.S. and in other countries on policy issues, emerging applications and market trends affecting telemedicine. Linkous has more than 20 years of experience in the nation's capital working in corporate and public sectors.
MDD: The term "telemedicine" is widely used, but I'm not sure everyone sees it the same way. What's your working definition of it?
Linkous: We take a very broad definition: Providing patient care from a distance, using telecommunications. And patient care can be defined broadly in that respect too, so we would include things like mhealth (mobile health), telehealth, telemedicine, telecare, remote monitoring. There are lots of different variations of it, but it's all providing healthcare over long distance using telecommunications.
The distinction I would have with things like healthcare information technology is that they're involved in the technology part of it, and involved specifically with electronic health records, so the HIT component tends to be more administrative support systems and clinical support systems that are focused on the networks and the technology, whereas for ATA, while certainly the technology is part of it, the focus is on patient care and on delivering healthcare services.
We do have a lot of technology companies that are part of ATA, but it's very different than, say, the Healthcare Information and Management Systems Society (HIMSS). HIT tend to involve and be championed by CIOs of hospitals. We have some CIOs as members, but that's not the main focus of what we do.
MDD: What's the business model for telemedicine? What are its benefits?
Linkous: Telemedicine is a very broad term, so the market is very broad and the business models are multiple. The traditional telemedicine models that people have thought about since ATA started 16 years ago have been a large hospital that establishes a network, typically a hub-and-spoke network, out to a clinic in another state. Then they would pay for that based on reimbursements or grants of some sort maybe some subsidy from the hospital system to get that going. And then alongside it were the teleradiology services, which really are an outsourced service provided by radiology practices. And that was really the two components of telemedicine.
Today, it's much more diverse; the number of services provided off what we would call the traditional telemedicine networks are a minor part of what the total services are. Today we estimate about 10 million Americans get services remotely using telemedicine during any one year. Of course, the majority of that would be in radiology and imaging services, or maybe some sort of monitoring like neurological monitory during a surgical procedure on the back 80% of that is done remotely. Or monitoring implantable devices like a pacemaker; about a million people get that. Then you have new services that are coming on like outsourced neurology or remote monitoring in the ICU.
All of those varieties of new services, new players, new companies, are really starting to transform healthcare. These Internet-based firms that are providing services into the home, often in cooperation with the big health insurers or employers, are the real true definition of disruptive innovation. Companies or organizations that are not traditional healthcare firms are providing these services from a new perspective, and sometimes even competing with hospitals or clinics by providing services in a new way.
The business plans in some cases is part of an integrated delivery system as we move to accountable care and managed care in the home. As a hospital moves out and wants to expand its footprint, expand referrals, sometimes those hospitals will underwrite these kinds of telecommunications networks just because it makes business sense. So it's a very eclectic group, but they're all expanding dramatically.
MDD: I've been covering the med-tech sector for nearly 20 years. It seems like I've been hearing it said that "telemedicine's time has come" during almost that entire period. Has it truly now come?
Linkous: Well, you're talking about 10 million patients and I'd say that within 18 months you're talking about 20 million patients, so yeah, I'd say its time has come. I said about a year ago that I would never use the phrase "around the corner" again we've turned that corner and now are down the street. There are still some struggling things, but if you step back and look at it in totality if you look at mhealth, that enormous market that is primarily hype at the moment, but there's a lot of stuff there that's going to end up sticking in the end.
MDD: I have seen comments by those who follow telemedicine that the biggest thing holding back adoption is a lack of reimbursement, while for others, it's a political question. What do you see as the key limiting factors standing in the way of a leap forward?
Linkous: I used to say reimbursement, and certainly reimbursement is still an issue, but I wouldn't say it's the biggest thing anymore because 90 million Americans are getting managed care now and managed care doesn't require a reimbursement mechanism to get reimbursed for telemedicine. Employer-based care and private payers also are turning to telemedicine, so reimbursement is an issue, but I wouldn't say it's the greatest issue.
I think a bigger issue is the implementation of these different business models, an understanding of how it works that's one of the barriers we have right now. Everyone is moving in a different direction. For the first time, hospital CEOs are starting to say that telemedicine is an important part of our business strategy because we're moving forward. It's a land grab in hospitals right now. Every hospital wants to build up referrals and take control of other hospitals and insurers are starting to become providers.
Everybody is getting into everyone else's network, and telemedicine is kind of part of that, so it's becoming part of the business plan. That's an important change in thought that's just occurring in some areas. That has not hit most areas across the country yet, but it will.
You have large entities like the Mayo Clinic or UPMC or Cleveland Clinic, they're starting to develop a national brand, and if you develop a national brand and get involved in 20 different states providing referral services, specialist services, providing protocols that can be adopted locally, those all call for telemedicine as part of your business plan. So it has become an integrated part of where healthcare is going. And that's very different. We used to talk about, "Well, we need to get code 99302 approved so we can start doing consults in Iowa," but that's a whole different world from where we are right now.
MDD: Why do you think other countries I'm thinking Australia here have embraced telemedicine on a national level, while U.S. lawmakers seem to take little interest in the possibilities?
Linkous: Well, when you have countries that have more of a socialized healthcare system and more of a national managed care approach, then it's very logical that you would choose telemedicine. That's why networks like Veterans Affairs are very heavily involved in telemedicine, because they have somewhat of a managed care system.
But if you're operating under the traditional fee-based system, as we have in this country, then it's much more complicated. We have the best healthcare providers and the worst healthcare system in the world. That's part and parcel of where we are with telemedicine. We have barriers in the form of federal policymakers who are afraid if they start allowing physicians to charge on a fee basis for telemedicine it's going to break the bank. It's not true, but it reveals a lot about their thinking; we're still infested with Luddites in many ways.
MDD: Conversely, the state legislatures seem to be where the action is insofar as making policy changes that impact telemedicine's availability are concerned. What's the progress report there?
Linkous: Three more states have adopted legislation this year mandating telemedicine benefits from private payers, so we're now up to 14 or 15 states. That's a rapid change, and a lot of other healthcare systems are looking at opening up reimbursement to Medicaid. A little over half the states are reimbursing for a lot of different types of telemedicine. Of course, teleradiology, imaging services, have been reimbursed for years a lot of people miss that when they talk about telemedicine.
(In Part 2 of this interview next week, Jon Linkous talks about the keys to making the pitch for telemedicine, its promising use in urban areas, healthcare segments where telemedicine is having the most impact, measuring telehealth's effectiveness, and the growing investor interest in the sector).
Published August 30, 2012