Say you’re a Midwestern farmer in a hospital bed, recovering from surgery or a major illness. It’s time for the nurse’s check-in, but there’s no knock on the door.

At Mercy Hospital in St. Louis, a camera attached to the wall over the foot of the bed whirls around, as a video monitor next to the camera lights up to show a smiling face with a headset on.

“Good afternoon, this is Jeff with SafeWatch,” the smiling face says. “Just doing my afternoon rounds.”

It’s a little hard to shake the Jetsons vibe in this telemedicine training exercise, but this kind of health care isn’t just futuristic; it’s happening now and expanding. On Oct. 6, Mercy Hospital will open its new telemedicine mothership. The idea isn’t so much to keep closer track of patients at the St. Louis hospital, as to treat thousands of patients spread across five states.

The new facility will offer an increasing number of patients in remote parts of the rural Midwest and South the sort of detailed health monitoring offered at large, well-staffed hospitals in cities and suburbs, says Tom Hale, the executive medical director of Mercy Virtual.

“You can monitor their heart, their blood pressure, their respiratory rate, their temperature on a 24/7 basis,” he says. “You can monitor their position — so you can tell if they’ve been out of bed. You can tell if they’ve turned in bed.”

He says the quality of telemedicine can be high, and it’s cheaper than in-person care. Hale and his team now largely provide care for patients in rural areas, but the use of their system may soon extend quickly to a different group of patients: baby boomers anywhere who want to stay in their homes instead of moving to a nursing facility when their need for health care increases.

Industry analyst Sarah Turk of IBISWorld says that expanding population could propel telemedicine to a $3.5 billion industry by 2020.

“Coverage will be expanded to include more physicians and more specialties and also a range of communications,” Turk says. “So instead of it being only interactive video consultation, it could be text messaging as well.”

Still, the telemedicine boom faces some big challenges, she says. Many insurance companies have been slow to pay for these services. Medicare, the largest health insurer for Americans over 65, is a financial powerhouse; insurance companies often follow Medicare’s lead in determining which treatments and procedures they’ll cover.

Right now, Medicare only covers the use of telemedicine in rural or medically underserved areas, and only when video conferencing is used. But telemedicine has broadened as the technology has developed. Now that doctors and nurses could use a smartphone app to, say, monitor their patient’s falls in the home, insurance companies and Medicare need to rethink their payment criteria, proponents say.

But Dr. Ashish Jha, a health policy analyst and professor at the Harvard T.H. Chan School of Public Health, says insurance companies have good reason to hesitate and be skeptical.

“If telemedicine really saved money, payers would be falling over themselves paying for this stuff, right?” Jha points out. “Because it would actually benefit their bottom line.”

Telemedicine does seem to provide good access to quality medical care, he says. But even though it could save money, that’s not what’s happening.

“It tends to be an addition,” he explains. “You do the telemedicine; it leads to more tests. It leads to more follow-up visits. And, over time, when you look at the data, it turns out that telemedicine overall is not necessarily a big cost saver.”

Nonetheless, executives at Mercy Hospital are betting that expanding their use of telemedicine will be a good deal. With its new facility, the hospital can monitor nearly 7,500 acute-care beds in five states, and the plan is to keep expanding.

This story is part of NPR’s reporting partnership with KCUR and Kaiser Health News.

Copyright 2015 KCUR-FM. To see more, visit http://www.kcur.org/.

Transcript :

RENEE MONTAGNE, HOST:

Let’s turn now to health care. Next week, a major new medical center will open in St. Louis. It will actually treat thousands of patients from five states, none of whom will be in the building. Mercy Hospital is being described as a telemedicine mother ship and a model for how rural health care can be delivered. But as Alex Smith from KCUR in Kansas City reports, a lot of insurers are reluctant to pay for it.

ALEX SMITH, BYLINE: Say you’re a rural Midwestern farmer in bed recovering from surgery or a major illness. It’s time for the nurse’s check-in, but there’s no knock at the door. At Mercy Hospital in St. Louis, just over the foot of the bed in a training room, a camera whirls around and a monitor lights up to show a smiling face with a headset on.

JEFF: Good afternoon, this is Jeff with SafeWatch. Just doing my afternoon rounds.

SMITH: It’s a little hard to shake the “Jetsons” vibe, but this kind of health care is already alive and growing. And the new virtual facility will provide even more patients in remote parts of the Midwest and South with health monitoring that’s comparable to what you could get in a big hospital.

TOM HALE: You can monitor their heart, their blood pressure, their respiratory rate, their temperature on a 24/7 basis. But even more interesting is you can monitor their position. So you can tell if they’ve been out of bed. You can tell if they’ve turned in bed.

SMITH: Tom Hale heads Mercy Virtual. He says telemedicine can be high quality and cheaper than in-person care. A lot of what Hale and his team now provides is care for patients in rural areas. But its use may soon explode with a different group of patients – baby boomers who want to age at home instead of in a nursing facility. Industry analyst Sarah Turk of IBISWorld says that could propel telehealth to a $3.5 billion industry by 2020.

SARAH TURK: What we may see in the future, which will likely occur, is that coverage will be expanded to include more physicians and more specialties and also a range of communication. So instead of it being only interactive video consultation, it could be text messaging as well.

SMITH: But she says the telehealth boom still faces some big challenges. Many insurance companies have been slow to pay for telemedicine, especially Medicare, the health care coverage for Americans over 65. Right now, Medicare only pays for telemedicine in rural or medically underserved areas and only when video conferencing is used. But telemedicine has broadened. Its technology has developed. And now it could, say, use a smartphone app to monitor falls in the home. So insurance companies and Medicare have to rethink their payment criteria. But Harvard researcher Ashish Jha says they have good reason to be skeptical.

ASHISH JHA: Look, if telemedicine really saved money, payers would be falling over themselves paying for this stuff, right, because it would actually benefit their bottom line.

SMITH: He says telemedicine does seem to provide good access to high-quality medical care. But even though it could save money, that’s not what’s happening.

JHA: What actually tends to happen is that it tends to be an addition, meaning you do the telemedicine; it leads to more tests. It leads to more follow-up visits. And over time, when you look at the data, it turns out that telemedicine, overall, is not necessarily a big cost saver.

UNIDENTIFIED WOMAN: A MAP (ph) is 55.

SMITH: Back in St. Louis, a room full of Mercy nurses gaze into arrays of computer screens and watch patients who are, in some cases, hundreds of miles away. With its new facility, the hospital says it could monitor nearly 7,500 acute-care beds in five states, and they plan to expand even more. For NPR News, I’m Alex Smith in Kansas City. Transcript provided by NPR, Copyright NPR.