Practice Management News

Do Reimbursement Limitations Deter Telemedicine Integration?

By Jacqueline DiChiara

- Telemedicine and reimbursement do not always go hand in hand. Reimbursement complications often hinder telemedicine's progression within the healthcare industry, as RevCycleIntelligence.com reported.

Telemedicine

Nadia de la Houssaye, Partner at Jones Walker LLP, spoke with RevCycleIntelligence.com about the evolving connection between reimbursement and telemedicine. Having recently returned from the American Telemedicine Association Conference (ATA) in Los Angeles, Houssaye offers a contemporary perspective on what is around the immediate corner and on the distant horizon regarding reimbursement challenges and opportunities within the telemedicine realm of the healthcare industry.

RevCycleIntelligence.com: What were the primary Medicaid and Medicare reimbursement takeaways from the ATA conference?

Nadia de la Houssaye: As noted by the CEO of the American Telemedicine Association, Jonathan Linkous, the regulatory focus is shifting away from reimbursement issues and focusing more on allowing telemedicine access without state barriers. Although Medicaid, Medicare, and private health insurance reimbursement will always be sought, telemedicine is thriving and profitable with or without governmental reimbursement. 

The private sector is investing significant funds and entering into collaborative partnerships to alleviate costs, accelerate program implementation, and drive innovation. Also, as consumers invest significant funds to proactively manage their own health, the direct to consumer telemedicine market continues to be one of the fastest growing markets.

RCI.com: As RevCycleIntelligence.com previously reported, legislation efforts are often slow to catch up regarding telemedicine, especially as the transition into value-based pay progresses. What are your thoughts?

NH: Competing state laws, coupled with conflicting regulatory issues between state laws and state medical boards, present one of the greatest barriers for interstate telemedicine implementation  and adoption. All 50 states currently have different regulatory requirements, as well as 50 different licensing board requirements. Moreover, state law is evolving and changing daily. A telemedicine provider may be compliant today and non-compliant tomorrow, as occurred  recently in Texas.  As an attorney working with these healthcare companies, this is one of the most challenging areas facing the telemedicine industry today.

RCI.com: What is the overall impact of the Affordable Care Act on telemedicine?

NH: The Affordable Care Act’s penalization of uncoordinated, volume-based delivery of health services that results in high hospital re-admission rates, coupled with the Act’s incentives for integrated, patient-centric, value-based health care delivery models, mandates the integration of telemedicine into the healthcare provider’s delivery model. Years of devise tracking data indisputably establishes that telemedicine provides higher quality, more affordable healthcare options. And more importantly, utilization of telemedicine will provide quality care to all individuals, many of whom would not otherwise have access.

RCI.com: What primary challenge does reimbursement pose within the telemedicine spectrum?

NH: Historically, one of the biggest challenges facing reimbursement for telemedicine services was the lack of hard evidence establishing the cost savings and patient outcome. Today, the clinical and devise data overwhelmingly demonstrates that the integration of telemedicine in the care of patients not only reduces hospitalizations and re-admissions rates, but also improves patient outcome. This is particularly true in the remote monitoring of individuals suffering from chronic medical conditions.

RCI.com: A great deal of Medicare spending goes toward caring for Baby Boomers' chronic conditions, as RevCycleIntelligence.com reported. How can telemedicine alleviate this burden?

NH: Corporate America is investing billions of dollars into the telemedicine industry. Investors are closely monitoring medical devices and understand that telemedicine is essential to the future of healthcare, largely due to changing demographics and reimbursement models. The capacity of new technologies to remotely monitor chronic health problems in an effective, secure, and real time manner, allows for better management of chronic conditions in the home setting.

One of the areas I’m most excited about is the integration of telemedicine in the home health setting. As baby boomers age, remote monitoring of chronic medical conditions will change the landscape of healthcare. The goal is to remotely control the advancement of chronic illnesses – to keep the patient well and at home, instead of sick and in the hospital. Remote home monitoring can also include providing sitter care for those who are aging, but who are not in need of assisted living. A small camera can be placed in the aging person’s room, with a remote sitter monitoring the person from a distal site. The sitter can simultaneously monitor numerous individuals, in an affordable and less intrusive manner than in home sitter care. What a great way for elderly, aging groups, couples, or individuals to stay in their own homes and remain independent as long as their health allows.