Telemedicine For Palliative Care Goes Where Doctors or Patients Can’t

Case studies of its use are supportive, but obstacles such as reimbursement and technological gaps remain.

Perhaps you have advanced cancer and need palliative care. This specialized form of medical care is provided to seriously ill and terminal patients to relieve symptoms and reduce your stress. It improves quality of life for you and your family.

But at the same time, the comfort of being home with supportive family members (and not having to travel long distances) is a form of palliative care. How does palliative care and remaining at home come together?

In a word, telemedicine, or the exchange of medical information from one site to another via electronic communications. If done well, research has found, it can be as effective as face-to-face care with your doctor or a nurse in improving your health, research has found. That’s particularly true if you live in a rural area.

The technologies it employs include two-way video, email, smartphones, and other wireless tools.

"Common uses of telemedicine for palliative care include video visits for pain management and counseling,” says Gary Capistrant, American Telemedicine Association (ATA) chief policy officer. “A major barrier is that many payors, like the largest single payor (Medicare), don't cover telehealth to a person's home.”  

A bill in a Congressional committee, if passed, would include coverage of Medicare telehealth if you are a hospice patient at home. Other initiatives are underway that could make it easier for you to be reimbursed for at least some of the cost.

Supporters of telemedicine cite case studies and pilot programs as evidence of the technology’s ability to bridge a growing gap in medical care, particularly for those patients who have serious illnesses, but can remain at home – short of hospice care.

It also responds to the imbalance created by a shortage of doctors who even have enough palliative care training and the anticipated palliative care tsunami you may be part of called the Baby Boom generation. The oldest are now close to age 70; some will undoubtedly need it soon.

One doctor turned entrepreneur, Michael Fratkin, MD is making waves of his own with a new business called Resolution Care, which employs video conferencing that can involve managing your medications and offers consultation on controlling symptoms.

Patients pay a fee for the service because insurers in most cases won’t cover telemedicine. Fratkin is banking on growth in the use of telemedicine to cover his own costs. He’s doing his part by including an educational component in his business that consults with hospitals and medical centers on setting up cost-effective networks.

Mike Baird, the CEO of telemedicine startup Aviza, is taking another approach through the use of telemedicine carts.  Those are comprised of computer monitors mounted on rolling carts that gives you the ability to immediately tap in to your doctor’s office from home.

He says it simply piggybacks onto a burgeoning technological culture that wants immediate contact and gratification. “We’re at that point now where you expect it: Why in the world can I not talk to my doctor via cell phone or over video?’’ he told Forbes.

Baird keeps the fledgling company’s revenues to himself, but does say it’s growing quickly and had 300 customers as of June. It’s also operating in one-third of the largest hospital systems in the U.S., he adds.

“We had a customer that was doing a demo of our product for three months; a trial of the product,” Baird says. “At the end of three months they said, ‘Wow, your product saved three lives during that time.’”

What the Forbes story lacks, as does the coverage of Fratkin’s startup, is the cost to the consumer, the seriously ill or even dying patient sitting at home on her couch and in need of palliative care.

Iowa based UnityPoint at Home, whose bread and butter has long been in-person at home care, also believes in telemedicine. It has faith that technology can provide much of the same day-to-day assistance many patients with a chronic disease need, such as advice on medication and pain relief.

“(We’re) expanding the use of telehealth for multiple populations and programs, including home care, palliative care, and hospice,” says Lori Bishop, RN, the executive director of clinical transformation.  

Bishop adds that UnityPoint consumers (patients and their families) see the value in telehealth for monitoring of biometric information, as well as the benefits of video communication.

The technology is enabling a more collaborative relationship among patients, their families, and the healthcare team, UnityPoint believes. “Shared decision-making is enhanced through telehealth, which allows consumers to make informed decisions about their health based on their definition of quality,” Bishop says.

The regulatory climate, which hasn’t caught up to the value of telemedicine, is beginning to loosen. Some lawmakers at the federal and state level are encouraging the expansion of telemedicine in healthcare. But, before that happens, confidentiality must be a certainty and technological platforms, such as video, must be secure. Not an easy task.

Meanwhile, when it comes to you and your desire to use telemedicine, your chances remain spotty at best. But, as proponents like Fratkin and Baird continue to lead by example, it’s bound to spread.

If telemedicine could help you or someone you care about, talk to your doctor or hospital about whether it’s available. You can also contact the ATA with questions. Remember, though, that even if you can get it, it’s going to cost you. On the other hand, the result could be well worth it.