Telemedicine was supposed to be a game changer. In 2013, Transparency Market Research valued the global video telemedicine market at $559 million.
In January 2015, my boss, J.P. Medved, included telemedicine in his top medical tech trends of 2015 prediction post. In April 2015 I wrote, “The biggest area for growth in EMR tech is telemedicine.” Experts like Martha Vockley, a principal of VockleyLang, LLC expected “a flurry of experimentation” in “new, systemic delivery models for telemedicine” over the next decade, and “Not just in remote locations or for select patient populations.”
My Top 5 EHR Trends for 2016 post predicted that telemedicine “[would] blow up” in 2016. At the time, telemedicine was getting follow-up care to recovering stroke patients in rural Minnesota without the hours-long (and often snowy) drives. The US’s largest drugstore chain, Walgreens had recently partnered with telehealth provider MDLive to expand their virtual care collaboration to 20 more states.
Last summer, the U.S. Department of Agriculture funded five pilot, telemedicine projects for $1.4 million to fight opioid addiction in southwest Virginia, Tennessee, and Kentucky.
In Gartner’s latest Hype Cycle for Telemedicine and Virtual Care, Mike Jones and Thomas J. Handler, M.D. wrote that HDOs are “on the threshold of a seismic change” and “now recognize the value of virtual care and telemedicine.”
And yet, according to Piotr Kulesza, “2016 brought the first signs that telemedicine solutions were struggling to get meaningful adoption rates (e.g. Meedoc closing their service). Teladoc, a US public company, facilitated 202,566 remote visits in Q3’2016, which annualized was equivalent to less than … 0.1% of total US physician office visits. Teladoc most likely aimed at a much bigger market share when they founded the company back in 2002.”
Kulesza predicts public disillusionment with telemedicine in 2017. “We need 10x better software which is interaction-centric and focused on improving vastly providers’ workflow.”
Let’s discuss some challenges hindering telemedicine adoption and some of the solutions HDOs are currently testing.
Paying for telemedicine is a perennial problem for HDOs. Payers won’t pay for telemedicine like they pay for in-person visits. Making it difficult to pay doctors the same, which makes it difficult to incentivize providers to adopt the technology.
Dr. Tripp Jennings, chief value and informatics officer at Palmetto Health, described the twin challenges of creating a telemedicine business plan and paying for it on HealthcareITNews. “You have to account for loss of acute care revenue and in-person visits, while you are trying to match that up with improved access, larger scale and decreased operational costs,” Jennings said. “Most of the processes for demonstrating a return on investment prior to launching a solution do not work for the new types of healthcare delivery.”
“Pathway automation partnership” may prove helpful for maximizing telemedicine reimbursements. That’s how Digital Noema Telehealth founder and CEO Roque Espinal-Valdez describes his company’s recently announced integration with Lumeon, a software solution to connect clinical and administrative systems and automate the kind of tracking needed to make sure as much telemedicine as possible gets reimbursed.
Similarly, telemedicine company Zipnosis recently announced a partnership with MultiCare Health System and PokitDok to help automate claims processing. Orchestra One, a practice management solution, integrates scheduling, payment, and communication into one solution.
Policy still lags behind what’s technically feasible.
“Reimbursement currently only occurs in the rural areas,” Dr. Nima Mowzoon told me. Mowzoon is a neurologist and the CEO of TeleSpecialists, LLC. “With the expansion of telemedicine acceptance and increased demand for services, many state legislatures are working on broadening reimbursement parameters.”
The 21st Century Cares Act provoked the ire of, Jonathan Linkous head of the American Telemedicine Association. “It appears that the staff and members of the committee have once again been led by [the Centers for Medicare & Medicaid Services] and the Congressional Budget Office into asking for a study instead of taking real action,” Linkous said in a statement.
It’s unclear why the CMS would need more studies. Researchers have already completed at least 1,276 studies on the use of information and communication technology (ICT) in home care for communication between patients, family members, and healthcare professionals, at least according to this lit review from the NIH.
Earlier this month West Virginia delegates approved a telehealth bill 95-4 that allows providers to prescribe mental and behavioral health prescriptions through telemedicine.
If passed by the Senate, House Bill 2509 could expand access to mental and behavioral healthcare to rural areas where state laws currently prohibit providers from prescribing certain medications using telehealth, which has exacerbated the state’s opioid abuse crisis. While HB2509 doesn’t lift the ban on prescribing opioids like oxycodone and morphine it does legalize telehealth prescribing of mental and behavioral health meds.
One impediment to telemedicine is that doctors are only allowed to treat patients who live in the state they’re licensed in. Rather than disincentivizing telemedicine, it really just limits how much telemedicine can help alleviate the discrepancies between high-demand and low-supply states.
“As telehealth services continue to expand and providers look for tools that allow them to monitor their patients outside of the typical office setting, the medical community must also continue to put pressure on payers and lawmakers to mandate coverage of these services,” Buckhaulter said.
“Currently, 26 states have telehealth parity laws that require private payers to reimburse providers for the telehealth services they perform. These parity laws prevent payers from withholding reimbursement for telehealth services based on the patient’s location, allowing the patient to attend telehealth sessions from their home or office without having to travel to a ‘qualified originating site,’ which remains a requirement for Medicare reimbursement.”
“The reimbursement amounts for telehealth services vary depending on a state’s legislation,” Buckhaulter said. “Many states with reimbursement mandates allow payers to determine the reimbursement rate for telehealth services. It is imperative that providers and their billing staff are aware of the telehealth coverage in their state and by their payers. Billers must be diligent to ensure that their providers are being paid accurately for the telehealth services they provide.”
Relatedly, “Medical providers are increasingly demanding the ability to use a mobile device for charting, billing, and communication in a HIPAA-secure method,” Buckhaulter said. “This will particularly be required as telehealth services expand.”
You may want to look into resources like the ATA State Telemedicine Legislative & Regulatory Trackers for updates on telemedicine policy. Regulations vary by state, so you need to research how insurance companies cover telehealth visits in your area.
Tips for HDOs
When it comes to provider adoption, Dr. Jennings said that, at Palmetto, they expect providers to dedicate a certain percentage of their time to virtual access.
“Or, in some cases, we’ve had revenue from that virtual access go into the provider reimbursement as more of a professional fee,” Jennings. “Because candidly, we’ve had many providers who want to provide care via telehealth, but they’ve said, ‘You are not going to add more work on my schedule, I need to be paid more.’ So that has been one of the challenges.”
AdvancedMD product manager Sherilyn Giauque recommends physicians decide what they want to accomplish by adding telemedicine before they begin. Maybe you want to make it more convenient for patients to see you, especially rural patients who have to travel long distances, are homebound or elderly, or who are going off to college.
Or maybe you want to offer weekend hours without the commute. Or do you want to grow your practice through telemedicine? You can also use telemedicine to improve patient outcomes by increasing continuity of care, which is particularly important for treating depression and other chronic conditions.
Giauque designed the company’s telemedicine platform, which integrates with the rest of the practice management, electronic health records, and patient engagement platforms for independent physicians.
“Once the goal is identified, then practices need to work with their staff on using the new telehealth tool in a manner that will help them reach their goal,” Giauque said. “Practices that use the technology wisely will see the benefits first; those that implement it without a strategy will likely spend some time figuring out where the most benefits can come from.”
“The best telemedicine systems act like a virtual clinic and are integrated into a cloud-based electronic health records (EHR) system,” Giauque said. “All you need is a computer with a webcam and an internet connection. If a telemedicine solution is cloud-based, practices won’t rack up expenses on costly software, servers, or IT services. For e.g., AdvancedTelemedicine is a cloud-based, HIPAA-compliant system that works seamlessly with AdvancedEHR.”
Look into whether the payers you deal with cover telemedicine in states without telemedicine parity legislation. Aetna, Blue Cross Blue Shield, Cigna, Humana, and UnitedHealthcare will often do it because it makes business sense.
Health tech incubator Health Wildcatters founder Hubert Zajicek told Telemed Mag that he’s seeing ACOs and related entities pushing asynchronous telemedicine platforms. One example is Friendly, which gathers patient data so the physician can decide whether a visit is needed before it happens.
“Because of their inherent constraints, ACOs are inclined to abbreviate the patient visit when it’s something that doesn’t need to be a live visit,” Zajicek said. And patients are liking it too. “People don’t want to wait in waiting rooms or be on the phone.”
“It’s never been a better time to add telemedicine to your practice,” Giauque said. “In fact, CMS and private insurers are recognizing that telemedicine can address provider shortages, especially in rural areas, and help providers improve the bottom line.”
Jennings can attest to that. “Our system has had is we have more patients visiting our practices and hospitals than we can care for,” Jennings said. “We are busting at the seams, so there is a constant recognition that we have to change our delivery model.”
There’s also a shortage of specialists in the US, meaning specialists’ time must be used as efficiently as possible. “According to the Association of American Medical Colleges Center for Workforce Studies, there will be a shortage of 46,000 specialists over the next decade,” Dr. Mowzoon said. There are specialist shortages in psychiatry, critical care medicine, nephrology, and endocrinology.
Mowzoon sees the shortage hitting neurology extra hard. When it comes to strokes, every second counts, but a neurologist isn’t always on hand. “Many physicians are retiring, and others are shifting careers to outpatient neurology, potentially leading to a large gap in inpatient neurologists.”
Another factor adding to the dearth of specialist physicians is that smaller and more rural hospitals can’t always afford to hire enough specialists to meet demand for 24/7 access. Telemedicine could be a way to connect patients with a specialist whenever they need one, anywhere in the world.
The Grand View Research Inc. report claims that, with telemedicine, the Community Care Plan of Eastern Carolina was able to double the number of patients it could see during a week.
“Practices that use telemedicine will also see some cost-savings,” Giauque said. “The patient is not physically in the office, there is no need to prepare and clean an exam room for the visit. Another revenue benefit of telemedicine is a reduction in cancellations. The convenience of telemedicine means fewer cancellations and no-shows for patients who can’t get to the office because of a big snowstorm, an inability to get a ride, a sick child, and more.”
According to Recode, telemedicine is the biggest area for growth in EMR tech. To help future-proof your EMR software, consider a company that’s taking strides in helping providers offer medical services remotely.
“Demand will continue to grow, with boomers reaching the ages that care is needed the most, and due to the increasing number of individuals with access to health insurance,” Mowzoon said. “These factors, combined with the reduced access to physical coverage by physicians, will continue the expansion of specialized telemedicine.”
Transparency Market Research has predicted the global market for telemedicine will grow to $1,624.4 million by the end of 2020. Grand View Research Inc. predicts the market for telehealth hardware, software, and services will reach a whopping $2.8 billion by 2022 and says that consumer demand is behind the increase.
To avoid getting left behind, check out our telemedicine software category, where you can compare options or narrow down your options according to features including Appointment Reminders/Scheduling, Chat, E-Prescribing For Telepsychiatry, and Multi-Provider Practice.