In Washington, sometimes the most significant developments quietly creep up on you. No epic debate or triumphant bill-signing ceremony, but rather a collection of seemingly small events begin to tip the scales.
That’s what is happening today with telehealth. Almost under the radar, federal and state officials have been giving a much-needed push in support of virtual care. Though the technology has long existed, until recently the money had not followed. And sadly in our current fee-for-service healthcare system, little gets done without a payment code, even if it makes eminent medical and economic sense.
Consider some of the recent action. In November, the Department of Agriculture released more than $8.5 million in health-related grants to 31 recipients in rural communities. Many are using the money to purchase telehealth equipment such as high-quality cameras and broadband Internet.
The previous month the federal government issued rules expanding Medicare payment for a range of telehealth services. Caregivers can earn about $42 per month for chronic care management under the new regulations. Seven new procedure codes were also added, covering such services as annual wellness visits and psychotherapy.
And the end-of-year spending bill approved by Congress designates more than $26 million for telemedicine programs largely in rural communities and through the Veteran’s Administration.
Legislation filed in the new Congress would continue the trend loosening anti-kickback restrictions for the purchase of telemedicine equipment and requirements that physicians receive a separate license to practice in each state (a major barrier for doctors aiming to deliver virtual care to patients across the nation.)
Consumers can’t wait. Nearly 40% of 1,000 adults nationwide surveyed by PwC’s Health Research Institute say they would be willing to have an appointment with a physician via smartphone, representing a potential $42.1 billion market. Significant percentages of American consumers indicate they are eager for virtual care alternatives such as a device that attaches to a mobile phone, snaps an image of an ear canal or rash and transmits it to a physician for an instant reading.
States too are prodding healthcare providers to embrace the new technology. More than 40 states plus the District of Columbia, always on the lookout for savings in the Medicaid program, allow telehealth services for beneficiaries. About 20 states also require private insurers to cover some remote care.
That shouldn’t pose a problem. Most are already experimenting with e-visits, often through partnerships with new entrants skilled in the tech side of the equation. Virtually every large insurer has at least one partnership with a telehealth business. For big box retailers and national pharmacy chains, remote consults offer the chance to expand their suite of health services and continue to compete on cost. Many visits are priced under $50, compared to about $150 for office visits.
One large health system is counting on patients to use a few simple devices such as a thermometer, stethoscope or otoscope to transmit data to doctors at another location. Others rely on the mobile phone to collect information and communicate with clinicians.
Work done by our Health Research Institute suggests that patients known as “dual eligibles” because they qualify for both Medicare and Medicaid, are very receptive to the prospect of lower-cost, more convenient care that doesn’t require a trip to the doctor’s office – often between 9 am and 5 pm.
New possibilities emerge every day. California lawmakers have paved the way for teledentistry. The Doctor on Demand app, backed by more than 1,400 physicians, is expanding into mental health with the help of television’s Dr. Phil. Online consultations with psychologists start at $50 for a 25-minute session.
Market analysts and investors are bullish on the prospect of marrying medical care and technology, suggesting a bright future for this burgeoning industry. Privacy and security remain areas of concern, as well as interoperability challenges.
As Americans live longer and millions of more qualify for insurance coverage, many experts fear the prospect of physician shortages. Telehealth offers the prospect of relief. And as money flows differently in the New Health Economy, the tide on telehealth is finally shifting.