With improvements in technology, the physicians at Grandview Medical Center's Atrial Fibrillation Clinic are finding new ways to offer cardiac care to rural and out-of-state patients.
Econsults
Econsults is a new Medicare program using the old medical concept of Curbside consults. The program allows for reimbursable physician-to-physician collaboration to allow more opportunity for patients to have their care guided by a specialist. While the program is not cardiology-specific, Jose Osorio, MD, medical director of the Atrial Fibrillation Clinic and Cardiac Electrophysiology at Grandview, said the initiative has many benefits for patients.
"Econsults is the ability for us to evaluate patient records and collaborate with primary care physicians on the care of their patients, without seeing the patients," Osorio said. "It's not used for every case. If it is very complex, we may tell the primary care physician we need to see the patient in clinic. But the idea is to partner with primary care physicians to be able to provide patients access to a specialist's insight while staying in their own communities, saving them time and money."
Econsults has been piloted in other states and is now approved for wider application. "Medicare realized that the majority of patients referred to specialists don't actually see the specialist," Osorio said. "Only about 30 to 40 percent of referred patients see a specialist for a multitude of reasons. This is a way to close that gap."
Patients are charged a copay, and Medicare reimburses physicians for their time on Econsults. "Medicare has done research on the pilot program, and it did improve care," Osorio said. "It also shortened the time until a patient could be treated."
Telemedicine is another technology initiative that, while not as new as Econsults, is becoming more popular with physicians and patients.
"We virtually evaluate patients with a webcam or smartphone, either at their home or the initiating site," Osorio said. A lot of our patients come from Tennessee, Georgia, or other cities in Alabama. We offer this service for their convenience and to decrease the time it takes for them to have the initial evaluation.
"The service is most helpful for patients who meet certain guidelines, particularly those with atrial fibrillation. They have usually already seen a primary care physician and cardiologist. They have, by and large, had a complete evaluation for their atrial fibrillation. So, with an analysis of the records and by talking to the patient, we can have a very good idea of the treatment options. We can talk to them about whether ablation is an option or if medical therapy is the best approach. Often we can eliminate the need for them to drive six hours for me to tell them they are not a candidate.
"And even when patients do need to see me in person for an ablation or other procedure, the telemedicine consult has enabled them to get to know me in advance and feel more comfortable before having an invasive procedure.
Osorio finds the time spent on virtual care visits can often result in a more in-depth discussion than even seeing a patient in clinic. "When you are on a webcam, your attention is devoted to that person," he said. "On the phone you may be multitasking. When a patient is in the clinic, a physician may be looking at medical records. With a thirty minute teleconsultation, I end up having a lot more time to discuss treatment with the patient. We've seen enormous patient satisfaction."
Telemedicine is approved by many payers, but there are differing requirements. "Medicare approves and pays for telemedicine, but patients have to go to an initiating clinic in a designated, underserved area that has the equipment and initiate a telemedicine visit," Osorio said. "Some insurance companies also have specific criteria, but none allow for patients to be seen at home. If a patient wants to be seen at home, that's when we use cash pay.
"Initially I had some reluctance about seeing patients via webcam, but seeing how it has touched people's lives, facilitated the evaluation, and eased the anxiety, I have become a big proponent and am happy with where we are taking this."
Primary care physicians in rural areas are also pleased with the results. "The primary care physicians appreciate the partnership," Osorio said. "The patient can often continue to be treated by them, the primary care physician is learning how to manage the specific situation, and it becomes a good partnership."
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Jose Osorio, MD; Grandview Medical Center; Atrial Fibrillation Clinic and Cardiac Electrophysiology at Grandview; Econsults; atrial fibrillation; Tel
