Telemedicine: At a Tipping Point?
Telemedicine has been around in one form or another for many years. But the convergence of technology and need (care coordination, medical services in rural areas, etc.) is now driving rapid expansion. Whether this continues to the point where telemedicine is mainstream will be determined by regulatory action and provider inertia.
Increased Acceptance & Use of Telemedicine
The healthcare industry is constantly searching for new ways to enhance quality of care and serve more patients. With recent advancements in technology, more providers are relying finding that telemedicine can be an effective tool.
Specialty tools, such as teleradiology are steadily gaining acceptance as more providers discover the benefits in enhanced patient care The use of telemedicine tools and electronic communications (i.e. smartphones, email, webcam) has enabled providers to deliver patient consults, communication, physician consults, and chart transfers in convenient and innovative ways. These tools also offer useful and manageable ways to monitor, track, and share patient history and outcomes. Patient use of telemedicine tools is also on the rise, as new technology has offered simple ways to monitor and track personal health (i.e. blood pressure, heart rate, Rx, exercise, etc.).
While technology advancements have driven the development of new telemedicine tools, as with any new mechanism, patient and provider utilization varies. Misconceptions around complexity and regulation as well as the common resistance to trying something new have limited physician and patient adoption. Additional barriers to broad acceptance and use of telemedicine and tools are licensing and reimbursement.
Currently physicians in the U.S. are required to have a valid license in the patient’s state in order to provide medical care. Virtual-visit companies are limited to matching users only with locally licensed clinicians. These limitations have led 17 states to join a compact that allows doctors licensed in one member state to quickly obtain a license in another. When it comes to reimbursement, employer and insurer coverage varies depending on the type of service and the state. Medicare, in particular, has been highlighted as a laggard in paying for telemedicine “visits.”
The good news, despite some resistance, is that telemedicine appears to be gaining steam, especially in rural areas. From 2003 to 2013, the industry saw a 28% increase in telemedicine visits made by Medicare beneficiaries. And recently, HHS announced it plans to award $9 million in grants to health care officials in three states to test telemedicine in an effort to reduce overdose-related deaths in rural areas.
The benefits from telemedicine use are also catching-on with other insurers. As more private and public plans provide reimbursement, partnerships between health insurers and telemedicine providers are increasing. The American Telemedicine Association (ATA) and other organizations have developed accreditation programs to identify top-quality telemedicine sites versus the sites that consumers should be cautious to use.
Additionally, the AMA has approved new ethical guidelines for telemedicine, calling for participating doctors to recognize the limitations of such services and ensure that they have sufficient information to make clinical recommendations.
On the state level, the USDA recently awarded MaineHealth approximately $400,000 toward the advancement of telemedicine efforts. Currently, 32 states have passed “parity” laws requiring private insurers to reimburse doctors for services delivered remotely if the same service would be covered in person, though not necessarily at the same rate or frequency.
Increasing Support = Increased Use
As technology advances and various applications become more mainstream, telemedicine expansion is expected to continue.
For physicians, telemedicine provides an efficient way for health systems to improve patient outcomes and save on costs. Web companies such as Teladoc, Doctor on Demand and American Well are expected to host around 1.2 million virtual doctor visits this year, up 20% from last year.
Healthcare organizations are increasingly embracing telehealth as a solution to many of the challenges facing health care, even in the highest acuity environment, the intensive care unit (ICU).
For example, in Arizona, one hospital pioneered a 24-hour, collaborative tele-ICU program and during its first year of implementation reduced ICU length of stay by 21%. The elevated care provided in the ICU and improved ICU length of stay further contributed to a 31% reduction in overall hospital length of stay. The total length of stay reduction resulted in $2.3 million in savings for the hospital.
For patients, the use of telemedicine is higher than ever with a reported 15 million plus U.S. citizens receiving remote medical care in 2015, according to the ATA, which predicts utilization to increase to 30% in 2016.
Almost all (97%) of patients are frustrated by hospital wait times, according to a 2015 survey. As a result, telemedicine and virtual appointments are a persuasive option for many people seeking medical care. It was also found that 75% of patients who have not used telemedicine previously are interested in using it instead of an in-person medical appointment. Further, 67% said that telemedicine somewhat or significantly increases the satisfaction they have with their medical care.
As the industry shifts from volume-based to value-based payment, interest grows in any solution that improves outcomes and reduces costs. More hospitals and health systems are embracing telemedicine as one means to utilize available resources efficiently while improving patient outcomes.