Reimbursement, Regulation the Biggest Challenges to Telehealth
A new study found that telehealth may be the next shift in healthcare, but it is an uphill battle.
- The use of telemedicine is growing in the healthcare landscape. The Affordable Care Act and the expansion of accountable care strategies places more weight on keeping patients out of hospitals and healthy, which telemedicine plays a major part of. However, reimbursement issues and regulatory uncertainty are causing some hospitals and practitioners to remain cautious about adopting the technology.
Recently, Foley and Lardner LLP conducted a survey of 57 senior healthcare executives on the topic of telemedicine. In an interview with RevCycleIntelligence, Nathaniel Lacktman, a partner and healthcare lawyer at the company, spoke about the findings of the survey and what it means for the industry as a whole.
According to Lacktman, the study was conducted because the law firm believes telemedicine really represents the next monumental shift in the healthcare industry. It can solve a lot of the issues about patient access to care and can significantly expand the footprint of specialty experts from their local geographic region to across the country. If the industry can pick up the reimbursement mantel and push that forward, patients will start reaping the benefits of these new technologies and deliver healthcare in a cost effective and incredibly responsive manner.
The study found that 84 percent of respondents felt that the development of telemedicine services is either very important (52 percent) or important (32 percent) to their organizations. Only 3 percent said considering the technology is unimportant. On top of that, while only 6 percent of respondents believe that telemedicine programs as “mature,” only 8 percent said they did not have the technology at all. A majority of respondents, 64 percent, are already offering remote monitoring, 54 percent use store and forward technology and 52 percent use real-time interaction capabilities.
Lacktman said that these findings are consistent with current trends and the feedback the company has received from its clients. There are solutions out there for providers to use and they do not need to reinvent the wheel. He added that this was the first survey of its kind to be conducted by a law firm, making the results highly anticipated. However, there were some surprises.
“The support and vision behind telemedicine was even higher than I thought it might be, especially for the larger medical institutions where there can be a certain amount of institutional inertia that you see and a reliance on the existing, traditional paradigms of in-person delivery and receiving payment on Medicare fee-for-service,” Lacktman said.
According to the study, the biggest challenge to adopting telemedicine is reimbursement. Forty-one percent of respondents said they are not reimbursed at all for telemedicine services and 21 percent receive lower rates from managed care companies for telemedicine than for in-person care.
There is also a struggle of credibility and physician buy-in. The report found that 48 percent of executives say they are more concerned with convincing doctors about the credibility of telemedicine than they are with convincing doctors they will be compensated for practicing it (36 percent). Furthermore, 87 percent of respondents do not believe a majority of patients will be using telemedicine services three years from now and almost one-quarter said they anticipated fewer than 10 percent of their patients utilizing their organization’s services.
“In order for a car to drive it needs gas and in order for a provider or hospital to run they need revenue. Traditionally the revenue that healthcare providers have relied on is the Medicare program and fee-for-service in particular,” Lacktman said. “Although some telehealth based services are covered by medicare, CMS has stated that it does not cover the full scope of in person services the same way that they would cover if it were delivered via telehealth.”
He added that providers have also looked to commercial reimbursement like health plans and in many situations, the health plans are not paying for telemedicine based services unless they are required to do so. Some states have started implementing statutes requiring commercial health plans to cover telemedicine services. Currently, 21 states plus the District of Columbia already require this coverage and a dozen or so additional states are debating adding this coverage.
The laws are changing in a favorable manner, with more state boards of medicine talking about telemedicine and the scope of the practice. This is helpful because it lays out a road map for providers to follow and allows them to operate with a degree of certainty to reduce risk.
