Why aren't we moving towards telemedicine in specialty practices?

Thursday, June 28, 2018 | Lori Walsh

We hear so much about telemedicine and virtual care—and as consumers, we love the idea—but it doesn’t seem to be catching on as a daily practice in our CV programs. Why is that? In 2017, 31 percent of health care organizations used video-based telemedicine services and 34 percent offered remote patient monitoring, according to a KPMG survey conducted by HIMSS Analytics. Kaiser Mid-Atlantic has moved to 50%+ virtual visits within their system and that number is growing every year. What do they know that most practices cannot figure out? Let’s talk about why telemedicine is so hard to execute.

1. Technical Training and Equipment: Providing a reliable connection to some remote areas of the country, including rural America, is a major stumbling block for telemedicine. Plus, the proper equipment and training is very expensive. There are numerous companies in the market that provide hardware, software and turn-key solutions for telemedicine—don’t forget to do your research and poll your colleagues before committing to a company.
2. Reduced Continuity of Care: It’s great when a patient can see a provider at any time of the day, pretty much 24/7/365. However, that’s not always great from a continuity standpoint. Patients who use virtual clinics for acute visits find it very convenient, but this can also lead to poor continuity as well as mismanagement/poor management of chronic conditions when you are not seeing a consistent provider for each encounter.
3. Reimbursement Issues: Honestly, this is one of the major stumbling blocks for why providers (especially specialists) are still not using telemedicine to its fullest potential. Medicare restricts coverage for telemedicine services to rural counties and geographic areas that are considered to be a Health Professional Shortage Area (HPSA) or areas outside of a Metropolitan Statistical Area (MSA). Medicare may cover telemedicine services if the patient lives in a rural area and only if they are located at one of the following places when they receive telemedicine services:

• Hospitals
• Critical Access Hospitals (CAH)
• Hospital-based or CAH-based Renal Dialysis Centers
• Skilled Nursing Facilities (SNF)
• Community Mental Health Centers (CMHC)
• Physician or Practitioner Offices
• Rural Health Clinics
• Federally Qualified Health Centers (FQHC)

These restrictions prevent specialists who don’t have a rural population from providing these services and being reimbursed fully.

Understanding the most effective workflows and best practices takes time; don’t rush into offering this service until your program is fully trained. The last thing you want is a failed go-live launch!

If you can overcome the technical and reimbursement issues related to telemedicine, I strongly suggest your program consider adding this service. If you don’t feel confident in overcoming the hurdles today, you should still keep it on the front burner. With the predicted shortage in the physician workforce plus the aging baby boomer population, the need to deliver care other than through face-to-face visits will continue to grow. With that need comes a great reliance on virtual and telehealth delivery. Also, we know that commercial payers are constantly changing their payment policies, so it’s important to be aware of those changes specific to telemedicine and how they could affect your program. If you are ready to make the leap, below are the five reasons why telemedicine can and should work in your program.

1. Convenience to Patients: As a working mom with two kids and parents who require frequent doctor appointments, I find the idea of telemedicine very appealing. Consumers want convenient care and are willing pay out of pocket for appointments with providers that meet their needs, like after hours appointments or on-demand slots. A recent study by the National Business Group on Health finds that nearly all large employers are expected to have telehealth benefits in place for their employees by the end of 2018.
2. Improved Efficiency within the Practice: In Arkansas, where I live, providing health care in rural areas is a major issue. Physicians find themselves driving 2+ hours one way just to see patients in a rural community. Telemedicine can give that provider greater flexibility on days and times plus allow the windshield time to be turned into productive patient time. It’s a win-win for everyone!
3. Staying Competitive in the Market: We have an evolving patient population that is accustomed to doing everything on a smart device. As telemedicine becomes more prevalent in day-to-day medicine, patients will start shopping around for a practice that provides this service. This could even mean seeing a provider virtually from another city and possibly another state.
4. Provider and Employee Satisfaction: Balancing the demand of your daily work with your family life is hard at any stage in your career. A recent study found that 80% of physicians would consider video visits to promote a more flexible work-life schedule.
5. Increases Revenue: Telemedicine allows you to see more patients in less time. You can also reduce your no-show rate. With an average of 5%-7% no show rate, that’s thousands of dollars left on the table every year. Not to mention new patients, they are the life blood of a practice and telemedicine is a major attractor to the working generation, whether for themselves or family members. Telemedicine also counts as patient-facing encounters, which can help with your composite score under the MIPS program.

MedAxiom had a couple breakout sessions at the CV Transforum Spring’18 conference in April that discussed telemedicine and virtual care. We received such great feedback that this topic is now slated for the general session at the CV Transforum Fall’18 in Austin, Texas, October 11-13, 2018. If you haven’t already done so, please go check out the agenda and plan to attend! (The early registration discount ends soon!) If you cannot make the conference, we’d still love to hear from you as to why telemedicine isn’t taking off—or how it is!

 

 

Illustration: Lee Sauer

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