ClickCare Café

More Opportunities to Get Reimbursed with Telemedicine

Posted by Lawrence Kerr on Mon, Nov 17, 2014 @ 07:30 AM

In recent weeks, we had some good news for those providers using telemedicine to collaborate and care for their patients.

The Centers for Medicare and Medicaid Services (CMS) approved several requests by the American Telemedicine Association to expand healthcare services that are eligible for reimbursement. In the agency’s proposed Medicare rulemaking for 2015, coverage has been expanded to include:
  • More psychotherapy allowances
  • Prolonged serves in the office
  • Annual wellness visits
  • Remote testing
  • Non-face-to-face chronic care services.

This is part of an overall trend: in fact, Medicaid coverage of telemedicine has increased in 20 states and 21states now mandate private insurance coverage. The new CMS proposals are slated to go into effect January 1, 2015 and the notice can be found here.

 

And for our Quick Guide to one of the most reimburseable forms of telemedicine, click here:

ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: medical collaboration, hybrid store and forward medical collaboration, telemedicine roi, telemedicine reimbursement

The Hidden Costs of NOT Using Telemedicine in Long Term Care

Posted by Lawrence Kerr on Tue, Jul 22, 2014 @ 09:50 AM

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The people we know who run long-term facilities are fantastic folks. They're creative, caring, and clear-eyed. The need to be, too, because the pressures they face in providing long-term care grow every day:

  • Access to specialists is shrinking.
  • Regulatory parameters get stricter (and sometimes less logical) every day.
  • New changes with the Affordable Care Act create both pressure and uncertainty.

Even when everything is going smoothly for the patient, costs can be difficult to manage. But when a patient needs to be brought to a visit with a medical provider, or a series of visits with medical providers, costs can really soar.

Of course, studies have repeatedly shown that telehealth can help bring down the cost of these types of incidents. For instance, the January 27, 2001 article in the Journal of Gerontological Nursing showed that for a rural nursing home, telehealth reduced the cost of the consult by half. 

In our experience, however, the cost of the consult is negligible when compared to the full set of costs incurred when someone in long-term care gets sent to the ER or the doctor.

These are a few examples of the problems with a "let's just send her to the doctor or the ER" approach: 

  • Patients often experience pain, frustration, and discomfort when traveling to receive care.
  • Aides need to attend, often shaking up schedules and complicating care for other patients.
  • Concommitant issues like dementia can be exacerbated when a patient is removed from her routine and home.
  • The family must also attend (or be excluded from the information and decisions at the visit), causing:
    • Missed work.
    • Distraction and stress.
    • Travel.

 

What benefits have you found in using telemedicine in long term care? What costs are you beginning to notice when it's not used? We look forward to learning from your experience in the comments below.

And for our review of the options, pros, and cons of telemedicine options, get our Quick Guide here:

 

ClickCare Quick Guide to Telemedicine              Transforming Long Term Care Through Telemedicine

 

Image courtesy of bestrated1 on Flickr, used under Creative Commons rights.

Tags: telemedicine, telehealth, telemedicine roi, assisted living facilities, long term care, assisted living communities

How Telemedicine Could Remedy the VA Backlog & Shortages

Posted by Lawrence Kerr on Tue, Jun 10, 2014 @ 08:49 AM

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On Friday, Eric Shinseki, the Secretary of the Department of Veteran Affairs, arrived at the White House, and when he left 45 minutes later he was no longer employed.

This resignation comes after weeks of controversy and outrage around underperformance and coverups at the Veteran Health Administration. The New York Times has a good infographic on the panoply of issues which include data falsification, marathon wait times even for urgent medical issues, coverups, and manipulation of care to artificially improve indicators.

Shinseki's resignation may imply that the problems at the VA derive from this administration or even this individual. Unfortunately, that's far from the truth. As Jon Stewart insightfully detailed recently, these issues extend far past Shinseki's tenure, earlier than the Obama administration, and earlier in fact, than even the wars in Iraq and Afghanistan. 

There is no excuse for the negligence that we, as a country, have demonstrated in caring for our Veterans. But politics aside, the difficult truth is that there are a number of intersecting issues that are creating the VA wait times and care backlog. On the supply side, there is a nationwide shortage of primary care physicians. And the veterans' demand for medical services is simultaneously soaring. As vets are more likely to live from catastrophic injuries, and with vets from Vietnam to Iraq to Afghanistan needing care, the number of outpatient visits to the VA has grown by 26% in the last 5 years (with medical staff growing by only 18%). Primary-care appointments have grown by 50%, while the department’s staff of primary care doctors has grown by only 9%. And across departments, doctors are supposed to be responsible for 1200 patients but are caring for 2000. (See article here.)

Of course, as the New York Times reports, "Republicans say the problem is not a lack of money — the department’s $154 billion annual budget has more than doubled since 2006 — but rather inefficiencies in the delivery of care. Democrats say that the problem is a serious shortage of doctors and not enough hospitals." Either way, the problems for the VA delivering timely and quality healthcare is related to medical providers being asked to do too much with too little (whether that lack is of time, support, or money). Which is something that all medical providers can surely empathize with.

So what are the VA and its committed medical providers to do? If anything, pressure is increasing for quick fixes to a problem that is constrained in large part by numbers of patients, number of doctors, and severity of medical issues. One fix that we see is to use telemedicine to leverage the time and energy of the providers that the VA has. 

If the VA shortage of providers and resources resonates with you, these are some ways that telemedicine may be able to help: 

  • Telemedicine can drop readmissions and length of stay. Surprisingly, medical collaboration -- like that facilitated by telemedicine -- can improve numbers on both readmissions and length of stay
  • Telemedicine can save providers' time they're spent on care coordination. Most providers will tell you what this study proves: huge amounts of time are spent outside of patient care, coordinating care and waiting for patient data. Telemedicine, particularly hybrid store-and-forward telemedicine, can slash those wasted minutes and get you the data you need when you're ready to receive it.
  • Telemedicine can loop in providers that are outside the system, but within a single patient visit. Of course, the most obvious use of telemedicine -- to enable consults with other providers even within a single visit -- is still a fantastic way to leverage provider time.
  • Telemedicine can enable more providers to collaborate on complex cases, efficiently. Especially with the complexity of cases that the VA is seeing, multiple specialists and providers across the continuum of care are needed to care for a single patient. A medical collaboration platform will help you integrate all of these voices so that patients don't have to bounce from visit to visit with long wait times between each.

Looking for a telemedicine solution in your organization? We can help you sort through the options:

ClickCare Quick Guide to Telemedicine

 


Image courtesy of dvids on Flickr, used under Creative Commons rights.

Tags: telemedicine, medical collaboration, medical responsibilities, medical collaboration software, telemedicine roi, telemedicine solutions, decrease readmissions, decrease length of stay

Is Telemedicine The Key to Global Health Equity?

Posted by Lawrence Kerr on Wed, May 21, 2014 @ 10:38 AM

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This post comes to you from Baltimore, MD, where we are participating in the American Telemedicine Association's annual meeting of policy-makers and innovators from the telemedicine community.

We've been playing a part in the ATA meetings since 1995, when we were just beginning to pilot iClickCare in underserved school-based health settings. One reason we've always found this conference fascinating and helpful is because of its "social impact" orientation. For us and for the ATA...

Telemedicine is not about making money on a new technology (although the ROI effects are impressive). It is about making positive change for patients and for providers.

This year, that mission orientation was especially salient, with the selection of anthropologist, physician, and humanitarian Paul Farmer of Partners in Health to give the keynote speech yesterday. We loved Dr. Farmer's talk and have deep respect for his practical, bold work. In particular, a couple of comments stood out to us:

  • Because there is a lot of variation in health outcomes within a particular country, it's less helpful to speak of "international health" than it is to consider "global health equity." 
  • Technology is an exciting opportunity because it helps medical providers reach others, in rural or urban places, that don't have health equity. For instance, the national nursing hospital that Dr. Farmer and his associates re-built is based on the idea that specialists can be "brought in" through telemedicine.
  • One key principle in his work in Boston, in Haiti, and in Rwanda is treating some conditions in hospital settings, but often treating chronic disease at home.
  • A disease may not incurable. But without a delivery system, many people become "too poor to treat."

Many of our iClickCare users are based in the United States and don't tend to see themselves as in a development context, or as part of a global health equity movement, as Paul Farmer does. However, we have seen countless examples of how iClickCare has been used for social impact, international health, and advancing global health equity. For example:

  • Connecting surgeons in Kenya with colleagues in the United States to contribute experience around orthopedic issues. 
  • Providing remote followup care (from the US to Iraq) to an Iraqi boy who received pro bono reconstructive facial surgery in the US.
  • Giving school-based nurse practitioners in an under-resourced school a quick and efficient link to pediatricians who can "round out" school-based care.
  • Linking medical residents in the Dominican Republic and medical residents in Rhode Island to each other, to share diagnoses and treatment ideas on unusual diseases.
  • Connecting wound care nurses in NYC to specialists just 5 miles away -- but 90 minutes in city traffic.

Even by experimenting with telemedicine and medical collaboration, you are part of the global health equity movement -- all it takes is action, small or large.

If you're curious about other applications of telemedicine, we put together a free overview of options, here:

ClickCare Quick Guide to Telemedicine

 

Tags: international health, medical collaboration, telemedicine roi, good medicine, telemedicine solutions

Key Things Smart Buyers Look for in Telemedicine Solutions

Posted by Lawrence Kerr on Wed, May 07, 2014 @ 09:11 AM

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When it comes to using technology -- for medical collaboration, communication, meaningful use of medical records, or any other crucial function -- there are a lot of considerations that come into play.

In our relationships with current and prospective iClickCare users, we've seen decision parameters run the gamut from savvy to uninformed. And we were intrigued to see a recent report on key features that home health agencies look for in software, from Software Advice, a company that reviews medical software. In 385 interactions with home health software buyers, they found:

  • 97% of buyers prefer a cloud-based system over an on-premise solution.
  • Field support (mobile and remote access) was the most requested feature to better track care in the patient’s home.
  • First-time buyers want the benefits of going digital, and top reasons for purchasing included improving efficiency (58%) and “going paperless” (35%).

We think that this orientation toward cloud-based, efficient, adaptable systems that allow remote access is right on.

This is a smart way for home health agencies -- any group, really -- to make the most of their technology dollars, comply with regulatory issues, and positively impact patient and provider satisfaction. That's one reason we had concerns about a report that Time Warner Cable and the Cleveland Clinic are collaborating on a pilot project installing video conferencing hardware in patient's homes to lower hospital readmissions. This kind of focus on expensive hardware installations can actually make outcomes for patients worse. By not using simple software, cloud-based systems that can be accessed from anywhere, and leveraging hardware that providers already have (like the smartphone in their pocket), a lot of resources tend to be wasted. For that reason, we recommend keeping the following things in mind in any big health IT investment: 

  • Keep hardware investment to a minimum. Always see whether you can use existing hardware -- whether computers, smartphones, or other resources -- and invest your dollars in good software and systems. Hardware can easily go obsolete, while software can be updated.
  • Make sure it's easy to use. Medical providers have enough on their plate without having to learn complicated systems or having to operate completely new hardware. Look for something that leverages what people already know... and demand a well-designed, easy-to-use interface.
  • Prioritize flexibility and collaboration. Some systems can only be used or shared with providers that are "in the network." Look for a service that allows you to get consults and support from any provider, regardless of their status with your service.
  • Invest in systems that can be used from anywhere. As the study above shows, savvy buyers are looking for cloud-based services (SaaS) that can be accessed from anywhere -- that kind of flexibility tends to pay off in the long run.
And for our summary of telemedicine options and pros and cons, click here: 
ClickCare Quick Guide to Telemedicine
 

Tags: medical collaboration, telemedicine roi, patient satisfaction, provider burnout, assisted living facilities, telemedicine solutions, healthcare collaboration, decrease readmissions, decrease length of stay

How Hybrid Store and Forward Telemedicine Saved a Life

Posted by Cheryl Kerr on Fri, Feb 28, 2014 @ 06:08 AM

A guest post from Dr. Cheryl Kerr, pediatrician and co-founder of ClickCare...

A few years ago, I was in the middle of an afternoon of patients when a 18-year-old girl came in with trouble walking.

L's Mom had dragged her into my office despite L's protests that she had probably injured herself at swim practice. When I asked L to walk down the hallway, I got chills. It sure didn't look like a twisted ankle: a classic part of the neurologic exam (walk on your heels) showed her right foot did not dorsiflex. My first impulse was deep concern because I really needed a consult. But from whom? An orthopedist? A neurologist? A neurosurgeon? The usual wait times to get in to see any of those specialists can top 8 weeks. Who should be first? Which specialty was most appropriate?

Luckily, I was able to use an early version of iClickCare to send simultaneous consult requests to the orthopedist, neurologist, and neurosurgeon. Within hours, when they had a chance to take a look at the consult, the orthopedist felt that since it was not an injury, another speciality might offer more. The neurologist, 2 hours away by car, offered to see the patient, but absolutely could not fit her into the schedule for a few months.  

The next day, the neurosurgeon operated on L, removing a spinal cord tumor.

When people ask me why we chose a "Hybrid Store and Forward" model for iClickCare's telemedicine platform, I always think of L. We chose this kind of collaboration (instead of teleconferencing, secure text messaging or any other platform) because it is the only option that allows: 

  • Use of text, pictures, and video (crucial for sending a video of L's gait) 
  • When-you-get-a-chance consults that let colleagues respond on their schedule
  • No need to juggle time for video conference setup
  • Simultaneous consults to let you ask questions of multiple folks -- in this case, an orthopedist, neurologist, and neurosurgeon
  • Archiving of cases and media so that you can use them to teach and collaborate in the future

Curious how other providers use Hybrid Store and Forward telemedicine for medical collaboration and care coordination? We put together a free guide to pros and cons with a collection of case studies.

 

ClickCare Quick Guide to Hybrid Store-and-Forward

 

And for our overview of telemedicine options, advantages and disadvantages of different types, and a discussion of ROI: 

 

ClickCare Quick Guide to Telemedicine 

Tags: telemedicine, medical collaboration, collaboration, hybrid store and forward medical collaboration, telemedicine roi, Telemedicine and HIPAA, telemedicine solutions, care coordination

7 Ways Telemedicine Helps Compliance with Accountable Care

Posted by Lawrence Kerr on Wed, Feb 26, 2014 @ 08:52 AM

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Barely a day has gone by recently, that the Affordable Care Act (ACA), Accountable Care Organizations (ACO), or the Centers for Medicare & Medicaid Services (CMS) have not been in the news.

In the broadest strokes, the Accountable Care movement attempts to shift the health payment system from a pay-for-service (fee based) system, to a pay-for-performance (outcomes based) system. Of course, for hospitals that want to accept Medicare and Medicaid, these reforms are mandated. But the overall approach affects almost all practices, regardless of status or whether you are an ACO.

Part of the reason that these policies aren't going anywhere is that early data shows they're working. In 2012, ACOs established in the Medicare's Shared Savings Program generated nearly $400 million in savings, the Centers for Medicare & Medicaid Services said in a statement released last week. 

Despite the laws, it's not always clear how to use telemedicine to improve outcomes in a pay-for-performance system. Interestingly, telemedicine and telehealth has been identified as a key tool in compliance with Accountable Care. It is even written into CMS' final rule for the Medicare Shared Savings Program: accountable care organizations must "define processes to promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies.

So here are 7 ways telemedicine can help you comply with Accountable Care: 

  1. Telemedicine makes care coordination possible and effective. Just changing incentives is not enough to improve outcomes. As the New England Journal of Medicine reports, "Merely aligning financial incentives will not improve quality and reduce costs for episodes of care... True coordination of care is required to ensure the best possible outcomes." Telemedicine makes this kind of care coordination possible and effective, particularly in a hybrid store-and-forward context that adapts to provider parameters.
  2. Telemedicine makes transportation less necessary. Whether home monitoring or distance consults, telemedicine can save costs of unnecessary visits and lengthy transportation. When payment is linked to outcomes, even saving a patient or provider a single trip can make a big difference over an organization.
  3. Telemedicine leverages provider time. In an age of provider shortages, telemedicine can make each provider's minutes count as much as possible. Through consults, collaboration, and even remote patient visits, provider time is leveraged. 
  4. Telemedicine can decrease readmissions. Because telemedicine can help the right at-home care to happen, clarify which provider is responsible, and make sure patients follow through, telemedicine has been shown to have a strong effect on decreasing readmissions.
  5. Telemedicine can drop length of stay. Data shows that care coordination, especially the kind of collaboration supported by telemedicine, is one of the strongest ways to drop length of stay. And length of stay is a key outcome in Accountable Care.
  6. Telemedicine improves access to care. Telemedicine can improve access for the underserved in rural, urban, or Veteran populations. Especially as provider shortages worsen in different parts of the country, and for different specialities, this kind of access to care is proving crucial in keeping costs down and meeting patient needs.
  7. Telemedicine supports good patient care, regardless of political climate and payment changes. Truth be told, many of our colleagues have been using telemedicine to improve the ways they care for patients -- regardless of whether it's rewarded by the current political context. We think that's good practice, in every election cycle.

 

Click here for our free guide on the pros, cons, and ROI of telemedicine options:

 

ClickCare Quick Guide to Telemedicine

 

 

Image courtesy of chelseastirlen on flickr.com, used under Creative Commons rights.


Tags: coordinated care, collaboration, accountable care, telemedicine roi, communication with patients, telemedicine solutions, decrease readmissions, decrease length of stay, ACO, affordable care act

4 Tricks for Getting Reimbursed for Telemedicine

Posted by Lawrence Kerr on Fri, Jan 31, 2014 @ 07:49 AM

 

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Many people have been hearing telemedicine success stories and want to start using using technology to collaborate and connect with providers and patients.

Most folks use telemedicine to improve patient care and maybe make their lives as providers a little easier. However, those motives don't get around the fact that we all need to be paid for the work we do.

Reimbursement for telemedicine is a crucial part of making the practice sustainable. But it's not always easy to know how to make that possible when the political climate and reimbursement policies are constantly changing.

So here are 4 tips and resources to make sure you're paid for telemedicine:

  1. Just do it and worry about reimbursement later. Many of our colleagues have found that when they put collaboration and patient care first, the reimbursement ends up taking care of itself. So pay attention to reimbursement -- but if in doubt, just go ahead and care for the patient or collaborate with telemedicine and let the details sort themselves out later.
  2. Use the right codes. We've assembled a list of codes you can use to bill for telemedicine-related time. This is always changing, but keeping an eye on the right codes increases reimbursement significantly.
  3. Make sure you're billing for everything you can. Many providers don't know that in addition to patient-related time with telemedicine, you can also bill for time spent collaborating, and even charge a remote site facility fee. 
  4. Be smart about pre-authorizations. Always check if the patient’s insurance company needs a prior authorization. If so, text the pre-authorization information and patient insurance plan to the consultant.

 

Need guidance on telemedicine options? Get our guide for free:

ClickCare Quick Guide to Telemedicine

 

 

Image courtesy of 68751915@N05 on flickr.com, used under Creative Commons rights.

Tags: collaboration, accountable care, telemedicine roi, iPhone medical apps, compliance, telemedicine law

Can Telemedicine Lower the Cost of Healthcare?

Posted by Lawrence Kerr on Thu, Jan 23, 2014 @ 08:14 AM

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Telemedicine is thriving these days -- there is even an ad on prime-time featuring it -- and a key reason are the ways telemedicine lowers the cost of healthcare. One indicator of this is the political support: "Telehealth is a major contributing factor to increased health care quality, convenience, and lower costs," said Reps. Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio). And there is certainly anecdotal evidence from around the country, like this tele-dermatology program in Nantucket saving nearly $29,000 a year.

In fact, we've found that the people and organizations that use iClickCare experience such significant and immediate cost savings that we've even incorporated an ROI calculator on our website. Dr Michael Moore, director of a wound care program, reported that "During a 3 month period, 70 patients were treated solely using iClickCare with an overall healing rate of 93% and an estimated savings of $24,000 in transportation costs alone."

Of course, despite its clear potential and proof points, telemedicine doesn't always cut costs. It's important to look at projects like this one for lessons from the front lines about what really works, and what doesn't.

So if you're considering a telemedicine program in your hospital, practice, or region... 

5 things to keep in mind to ensure telemedicine lowers the cost of healthcare:

  1. As we shared in this post, you are not setting yourself up for success if you make huge investments in hardware. We recommend investing in software (which can be updated, and is generally the lowest portion of costs) rather than hardware which gets obsolete quickly. Use the equipment you already have, the spaces already available to you, and just start. 
  2. Give special attention to readmissions and length of stay. Readmissions within a month of discharge cost $16 billion per year. And as we all know, readmissions and length of stay are big parts of the ACA shared outcomes focus. So we're interested in data showing that medical collaboration may be one of the strongest ways to decrease length of stay... and in this Connected Cardiac Care program, which has achieved a 51% decrease in readmissions with telehealth monitoring.
  3. Prioritize rural areas or very urban areas. Geographically removed areas (whether rural or inner-city) find the most cost-cutting benefits from telemedicine. "By decreasing the importance of location for healthcare provision, telemedicine can help increase competition and further lower healthcare spending for primary care and specialist consultations... using technology to allow health care workers to quickly serve those where there is the greatest demand will create a more efficient health care system overall," says Ben Miller of the WFS.
  4. Use your people effectively. Because of the provider shortage, the leveling of access helps cut costs and use our provider workforce most efficiently. As Dr. Brian Rosenfeld, Chief Medical Officer at Philips Healthcare, said, "Telehealth offers the opportunity to provide the access, quality and cost that will be necessary to increase prevention and leverage our current workforce."
  5. Work in coordination with the Affordable Care Act. Telemedicine may prove to be the linchpin in controlling costs and outcomes as the Affordable Care Act comes into being more broadly, according to Mario Gutierrez, executive director for the Center for Connected Health Policy.

Overall, we've seen over and over again the cost savings that can be experienced through telemedicine. But we do suggest keeping it simple, start small, and start today.

For an overview of choices in telemedicine, download the Quick Guide to Telemedicine

ClickCare Quick Guide to Telemedicine

 

 

Image courtesy of seeminglee on flickr.com, used under Creative Commons rights. 


Tags: telemedicine, accountable care, telemedicine roi, telemedicine solutions, decrease readmissions, decrease length of stay, affordable care act

4 Surprising Reasons Telemedicine Is Thriving

Posted by Lawrence Kerr on Tue, Jan 14, 2014 @ 09:07 AM

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Telemedicine practitioners can feel isolated. They are often among a handful of people in their immediate practice or hospital who are using telemedicine to perfect care, improve outcomes, and make their lives easier. 

The truth, however, is that healthcare providers using telemedicine are part of a large, growing, and thriving community. When we started working in this field almost two decades ago, telemedicine was rare. Now, however, the most committed, innovative healthcare providers all use telemedicine in one form or another. 

Telemedicine is actually thriving. Here are 5 reasons why: 

  • Politics are catching up. As this article details, parity laws are going into effect in several states. Also, the Telehealth Modernizaion Act -- to establish a clear definition of telehealth -- is on its way to going through. "Telehealth is a major contributing factor to increased health care quality, convenience, and lower costs," said Reps. Doris Matsui (D-Calif.) and Bill Johnson (R-Ohio)
  • Telemedicine is reaching critical mass. Research and Markets is predicting 18.5 % growth in global telemedicine in the next 4 years. 
  • New providers are more familiar with technology. For some of the same reasons as we highlighted in our discussion of concierge medicine, and as this article discusses, new providers are adopting practices like telemedicine at higher rates.
  • Providers are using smartphones in their practice. According to Verizon, "38% of physicians with smartphones use medical apps on a daily basis, and that number is expected to increase to 50% this year. Two-thirds of healthcare providers said that implementing or improving their use of mobile technologies is a high or mid-level priority during the next 12 months."

We're thrilled to know that providers are connecting better, people are collaborating, and patient care is improving as telemedicine becomes more widespread.

 

If you're looking into the options, get our Quick Guide to Telemedicine here:

ClickCare Quick Guide to Telemedicine

 

Image courtesy of thomaslevinson on flickr.com, used under Creative Commons rights. 

Tags: telemedicine, medical collaboration software, accountable care, telemedicine roi, patient satisfaction, telemedicine solutions, ACO, affordable care act, concierge medicine, telemedicine law

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