New momentum to realize the opportunity of telehealth

On February 9, a new telehealth bill was signed into law that expands coverage for accountable care organizations (ACOs), improves flexibility for telehealth use under Medicare Advantage plans, and allows nationwide reimbursement for tele stroke care and home dialysis treatment. The new law provides the largest boost to Federal telehealth coverage and payment in 17 years.

Telehealth services use technology to provide health care, education and other health related services remotely (may or may not require significant distance of course). The underlying technology may represent video/phone teleconferencing, secure electronic transmission and/or remote patient monitoring.

Although the technology for telehealth services is not new, it has historically been reserved for residents of rural communities with limited access to services. It can also introduce state regulatory and liability challenges related to service delivery across state lines. 

As noted by the Public Health Institute Center for Connected Health Policy, “… in the field of telehealth, policy develops much more slowly than the rapidly advancing technology.”

The new law removes that impediment for Medicare Advantage and select other patient populations. Perhaps just as importantly, and as we have experienced over time, Medicare is a defining payer in the marketplace. As does Medicare, so do commercial payers. Given that reimbursement has been a long-standing impediment to introducing new clinical pathways, the new law partially removes that obstacle and puts telehealth on more comparable footing with the traditional office visit.

Why is this so important in the long-term? Because it is not just remote patients that have difficulties getting into the office visit.  It is you and me. The average wait time for the average office visit has increased 30 percent, from 18 to 24 days. Given that national health expense represents 18 percent of our GDP, it is in all our interest that we can be “seen” by a physician.

With telehealth, there is the opportunity to be treated more quickly, and in a more cost-effective manner, with better outcomes resulting from prompt attention. As an industry, we are familiar with acute on-set triggering the need for an Emergency Room visit and/or hospital admission. Although the services meet medical necessity requirements, some of these services introduce the question of what might have been preventable. To that extent that the patient was triaged, the diabetic symptoms identified and triaged by a physician earlier, perhaps acute on-set doesn’t occur.  The run to the emergency room/inpatient admission never happens. Better health.

One concrete program illustrating this success took place at the Veterans Affairs Pittsburgh Health System, treating diabetes patients. The “tele-diabetes” program combines an e-consult delivered over the phone with team-based care and follow-up. A study was performed to compare patients who were e-consulted vs. more traditional face-to-face follow-up. Consistent with our belief in the value of care management, both groups experienced a decrease in their A1C levels from 10 to 8.6/8.8 after one year in the study.

Telehealth services are different … certainly, at this point, there is not a suggestion about telehealth delivery outright replacing the office visit. It introduces another tool in our overall care management delivery offering. While we explore the new opportunity of telehealth services, we need to remain sensitive to the changing challenges in communication, setting (space is still important!) and adjusting revenue expectations for providers. Focusing on those services most amenable to telehealth viability (e.g. post discharge follow-up, prescription refill) will be key. 

Best news on the horizon …the telemedicine market is expected to top $113 billion by 2025, with a growth rate of 18 percent.

Better health, higher quality, less cost ….  The path leads to The Triple Aim.

Katie Christensen is a healthcare consulting manager within the Population and Payment Solutions group of 3M Health Information Systems. 

Want to learn more about innovative telehealth programs? Listen to our podcast episode.

http://www.healthcareitnews.com/news/telehealth-policy-changes-mean-big-revenue-opportunities-hospitals

https://www.healthcarelawtoday.com/2018/02/14/top-5-ways-telehealth-will-change-under-the-new-federal-funding-bill/

https://www.beckershospitalreview.com/healthcare-information-technology/7-strategies-critical-to-telehealth-success.html

http://www.cchpca.org/sites/default/files/resources/TELEHEALTH%20REIMBURSEMENT%202018%20FINAL%20.pdf