Answers for a Healthier World

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As a board-certified emergency medicine physician, I have had the opportunity to personally experience the joys of providing virtual care. I have seen positive outcomes and happy patients and families. I have seen local communities thrive from the extra support. Overall, I am thankful for the opportunity to provide virtual care to a network of nearly 150 hospitals in 10 states. I firmly believe every virtual shift I work; I am helping us move a step closer to the promise that geography should not dictate the standard of care a patient and family receives.

I have learned many lessons over the last decade or so of virtual practice. I have given workshops and lectures across the globe on the topic and have seen the common barriers to adoption and expansion. Many come from within the house of medicine, such as the perception of care standards and “big brother/sister” issues. That is a long discussion for another time that I can tackle in future posts.


I would like to share my thoughts on the important topic of other barriers to entry centered around how we pay for telemedicine and some policy issues that exist that create barriers to fully embracing telemedicine. As we continue to move as a country from fee-for-service payments (volume) to value-based care payments (quality and outcomes > volume), we will see further need for expansion of telemedicine. The way we pay for care now and in the future could have a huge impact on telemedicine expansion.

According to the American Hospital Association®, growing evidence indicates that telehealth lowers health care costs while improving access and quality of care. And there's no doubt that consumers want the convenience of telemedicine. In fact, Becker’s Hospital Review found that telemedicine will attract 7M patient users by 2018.

Employers definitely have taken notice. According to the Mercer National Survey of Employer-Sponsored Health Plans, almost 60% of the country’s large employers currently provide medical coverage for telemedicine, giving workers the option to conduct video consultations with providers using a smartphone, tablet, or desktop computer.

Unfortunately, one of the largest barriers to telemedicine adoption is how we incentive telemedicine, especially regarding financial compensation to providers. A Wall Street Journal article reports, in a poll of 1,500 family physicians, only 15 percent used telehealth in their practice. But, an impressive 90% said they would if they were properly reimbursed.

If we want more providers, patients, caregivers and healthcare systems to use telemedicine, we have to make it financially beneficial for all parties.

Stay tuned for part two in which I will outline possible solutions to expand adoption.

What the Modern Healthcare Organization Needs from the CIO

Dr. Donald Kosiak serves as the Chief Medical Officer for Leidos. He is responsible for providing clinical subject matter expertise and perspective, knowledge, experience, leadership and direction to ensure collaboration and alignment to business strategy across the entire Leidos organization. Previously he has served as the Vice President for Medical Development and Executive Medical Director for Avera Health, a 32-hospital integrated medical system based in Sioux Falls, South Dakota, USA. In that role, he served as the chief medical officer of one of the top telemedicine programs in the United States. In addition, he has served as the elected Chief of Staff of the Avera McKennan Hospital, a 545-bed tertiary medical center located in Sioux Falls, South Dakota. Dr. Kosiak continues to serve in the United States Army Reserve as an emergency physician. He is a decorated officer having served three tours of duty in support of Operation Iraqi and Enduring Freedom. Dr. Kosiak attended medical school at the University of North Dakota. He completed his emergency medicine residency at the Mayo Clinic in Rochester, Minnesota. In 2010, he completed his Masters of Business Administration from the University of Mary in Bismarck, North Dakota. He is board-certified by the American Board of Emergency Medicine and the Certifying Commission in Medical Management.