Within minutes of Joe Burns being rushed to an emergency room in Fairmont with stroke symptoms, a skilled neurologist based 120 miles away was providing critical care with the help of video.
Emergency room staff at Mayo Clinic Health System in Fairmont tapped into the clinic's telestroke program, connecting a Rochester-based neurologist with Burns via video. The doctor was able to observe Burns, talk to his family and ask emergency room providers about his condition. Ultimately, the doctor determined Burns should receive a clot-busting drug that needs to be administered within three hours after stroke symptoms begin. Moments after getting the drug, Burns' slurred speech disappeared. Two years later, Burns still remembers the reaction when the drug worked.
"As soon as my speech seemed to make sense, it was just like a bunch of cheerleaders over there. I've never had a standing ovation before," the 75-year-old said.
More Minnesota patients may soon be getting treatment via "telemedicine" thanks to some key legislation passed by the Legislature this session. One of the provisions requires that health insurance companies pay the same rate for telemedicine appointments as they do for in-person patient exams. Another streamlines the process for doctors getting licensed to practice medicine in certain states.
Dr. Steve Ommen, medical director of Mayo Clinic's Center for Connected Care, said the recently passed legislation represents a major shift in how people view telemedicine.
"People are recognizing that the digital health care era offers a lot of value to patients, and we need to get legislation aligned to help people be healthy," Ommen said.
While people often think of video when they hear the word telemedicine, Ommen said it goes far beyond that. It also includes patients being able to access their health records via the web and physicians being able to send images and records to get second opinions. As for video technology, sometimes it is used in emergency situations like strokes. Other times it's a scheduled patient visit.
Mayo Clinic lobbied at the Capitol to get the law changed as a way to remove barriers to telemedicine. Repayment for telemedicine services has been a consistent issue. Ommen said Medicare only reimburses for video medicine if a patient lives in a rural or medically underserved area.
"You'd be surprised some of the towns that we all think are rural which don't qualify because they are too close to Rochester, too close to the Twin Cities," Ommen said.
The legislation passed in St. Paul will require all third-party payers to pay providers the same rate for telemedicine appointments as for in-person appointments — something Ommen said will make it easier for providers to use the method in the future. Lawmakers also approved a bill allowing Minnesota to join the Interstate Medical Licensure Compact. Minnesota is the ninth state to sign on to the compact. Minnesota physicians who meet the qualifications required under the compact would be eligible for expedited licensure in member states.
Ommen said that's important because the current licensure process for physicians is onerous. He is licensed in at least 18 states, which requires him to spend plenty of time filling out paperwork and answering questions. He said it's important to be licensed in other states so he can do follow-up care with patients who received treatment at Mayo and have returned home.
Sen. Julie Rosen, R-Vernon Center, sponsored the telemedicine insurance bill. The goal is to encourage medical providers to continue to expand their telemedicine networks — especially in rural areas of the state where patients often don't have access to medical specialists.
"My hope all along was to be able to provide great health care for our small communities and be able to keep our patients at home and help the families so they don't have to travel to Rochester or Sioux Falls or to the Twin Cities," Rosen said.
Virtual versus in-person visits
The growing use of telemedicine has raised concerns among some who worry whether the care provided will be of the same quality as an in-person visit. Rep. Tina Liebling, DFL-Rochester, said she opposed the idea of requiring all telemedicine appointments to be reimbursed at the same rate as in-person visits. Instead, she would have preferred some restrictions on the types of services eligible for the full reimbursement rate.
While Liebling said she is confident Mayo Clinic uses telemedicine wisely when it comes to treating patients, she worries about whether other providers might opt for virtual visits instead of in-person visits — even in cases when an in-person visit would be better for the patient.
"I think to say that any visit that's a telemedicine visit should be paid for at the same rate as an in-person visit brings with it a lot of questions," Liebling said. "And one is, are we going to be in some cases giving people less service? Isn't there value in actually seeing the patient and putting your hands on the patient?"
In the case of Mayo Clinic, Ommen said telemedicine is only used with patients the clinic already has a relationship with or to support local medical teams. So just how easy is it to use? With just a few clicks of his mouse, Ommen was able to connect via video with the Mayo Clinic Health System in Fairmont's emergency room. He can use controls to zoom in and out while talking with a patient.
Dr. Clint Masterson, an emergency medicine physician, said the telestroke service has been particularly helpful in providing quick treatment to patients. It has also been well received by patients.
"Families love it. It's nice for me to do a face-to-face, and I think it does help. People really appreciate it," Masterson said.
Burns agrees. He said that while being treated for his stroke, he felt like the neurologist he was talking to via video was in the room with him.
He added, "I'm very lucky. I was at the right place at the right time."