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W.Pa. physicians expand reach via video in telemedicine

| Saturday, Aug. 22, 2015, 11:15 p.m.
Guy Wathen | Trib Total Media
Dr. Hyagriv Simhan conducts a telemedical appointment with Michelle Quear from Magee-Womens Hospital on Tuesday, Aug. 4, 2015. Quear, who will have twins, spoke with Simhan from Hermitage.
Guy Wathen | Trib Total Media
Dr. Hyagriv Simhan conducts a telemedical appointment with Michelle Quear from Magee-Womens Hospital on Tuesday, Aug. 4, 2015. Quear, who will have twins, spoke with Simhan from Hermitage.
Guy Wathen | Trib Total Media
Dr. Hyagriv Simhan conducts a telemedical appointment with Michelle Quear from Magee-Womens Hospital on Tuesday, Aug. 4, 2015. Quear, who will have twins, spoke with Simhan from Hermitage.

Categorized as high-risk in her recent pregnancy, Nicole Fillinger had a tough decision to make — travel monthly from her West Virginia home to Pittsburgh for specialty care, or drive eight miles to Steubenville, Ohio, and connect with the same doctors via video.

She chose the virtual consultation and quickly cast aside her concerns after her first session with a doctor from Magee-Womens Hospital. Through a video connection, Fillinger and her doctor reviewed her blood pressure readings, medications, blood work and ultrasound results.

“Everything ran so smoothly,” said Fillinger, 33, who has high blood pressure and had experienced a miscarriage. “And it put my family at ease because we knew I was dealing with the best of the best.”

Telemedicine —­ the marriage of audiovisual technology and health care — is sweeping the country, embraced by patients using medical apps and doctors who examine them from remote locations with videoconferencing equipment. More than half of all American hospitals use some form of telemedicine, according to the American Telemedicine Association, a nonprofit advocacy group in Washington.

Western Pennsylvania is no different, as Allegheny Health Network, UPMC and the VA Pittsburgh Healthcare System all offer various forms of video medical care.

“We firmly believe that the future of medicine is going to be home-based,” said Dr. Tony Farah, chief medical officer at Allegheny Health. “Our prediction is that patients will become rapid adopters of these systems.”

‘Concerns of overuse'

As use of the technology spreads, debate rages over its benefits.

Supporters tout it as a convenient, cost-effective way to increase access to quality health care for people in remote locations.

Skeptics contend that face-to-face, hands-on medical care is imperative for all patients, and videoconferencing sessions between health care professionals who have never met hinder traditional teamwork and collaboration. Complex regulatory issues and questions about the technology's cost worry critics.

“I think there has to be concerns of overuse, and by that I mean patients who conduct a virtual visit when, under previous circumstances, they would not have visited a doctor,” said Dr. Ateev Mehrotra, a professor of health policy at Harvard Medical School. “That increases overall health care spending. Any cost savings on a per-visit basis may be trumped by an increase in utilization.”

Dr. Hyagriv Simhan, vice chairman of obstetrical services at Magee-Womens Hospital, routinely consults with patients by using video and raved about the system's convenience. UPMC has completed about 1,000 maternal-fetal medicine visits via video conference during the past year.

“There's this notion that somehow if you're not in the same room with the patient, it's not that easy to establish a rapport,” said Simhan, who spent a recent shift meeting with 14 patients consecutively while using his webcam. “I've not found that to be the case at all,”

‘Tip of the iceberg'

Officials at UPMC, the region's largest hospital network, point to an internal study as proof that virtual consultations are effective.

Their financial analysis of 542 people found insurers saved $86.60 per visit when patients used telemedicine instead of a traditional visit to a primary care physician, emergency room, urgent care facility or retail clinic, according to Natasa Sokolovich, executive director of telemedicine services at UPMC. Patients pay a charge or co-pay similar to a doctor's visit, but insurers save money on virtual visits by not paying claims for costly treatment in urgent care centers and hospitals, she said.

“This is the tip of the iceberg in terms of potential,” Sokolovich said.

Twenty-nine states and the District of Columbia have passed telemedicine parity laws that mandate private health insurers pay for telemedicine services the same way they pay for in-person visits.

At the federal level, legislators are pushing bipartisan legislation aimed at expanding coverage of telemedicine services under Medicare, which covers telemedicine use for only about 20 percent of beneficiaries across the country, according to Latoya Thomas, director of the State Policy Resource Center at the American Telemedicine Association.

Medicare generally reimburses only patients who live in rural areas, she noted.

“It's unfortunate and discriminatory,” Thomas said.

Not always welcome

A telemedicine program that began two years ago at Children's Hospital of Pittsburgh drew mixed results when it recently reached its halfway point, said Dr. Jeremy Kahn, a health services researcher, physician and professor at the University of Pittsburgh's School of Medicine and Graduate School of Public Health.

“Not all clinicians welcome this,” said Kahn, who leads the project at Children's. “For example, you're asking nurses or other health care professionals to take orders from physicians they have never met over a videoconferencing system.”

The Lawrenceville hospital began the program with a $1 million federal grant. It enables Children's doctors and professionals to examine and diagnose pediatric patients from outlying hospitals through a videoconferencing system.

In the year leading up to the program's start, more than 400 pediatric patients in rural facilities across Western Pennsylvania were driven or flown to Children's, where doctors examined and immediately released them, emergency room records showed. Officials said telemedicine could have saved $800,000.

“In many cases, from the patient perspective, telemedicine reduces the burden of travel and other unnecessary costs,” said Harun Rashid, vice president of UPMC International Services and International TeleHealth.

Fillinger, the West Virginian who used telemedicine during her high-risk pregnancy, is convinced that she made the right decision.

On April 4, she gave birth in Trinity Hospital in Steubenville to her son Rocco, who was a healthy 8 pounds, 3 ounces.

“I would definitely recommend videoconference for anyone who has had a previous miscarriage and for older pregnant women,” she said. “You get the best doctors, and you get them right at your local hospital.”

Ben Schmitt is a staff writer for Trib Total Media.

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