Tele Taking Off

Ceci ConnollyIn 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.

12 replies »

  1. That would make perfect sense. However, Skype is not HIPAA compliant and using it will get you in a lot of trouble.

  2. Its great to read what is happening from the view of the doctors.. Fundamental change is surely long overdue, we need change to be implemented right now.!! surely>

  3. You’re probably right Rob, because instead of letting physicians and other providers innovate different care options, the government and insurance companies are trying to force these options. But you see, physicians like yourself have taken themselves out of that position and you are establishing treatments and communications that fit yourself and your patients. That is the way it should be.

  4. I’ve been doing direct primary care for the past 2 years, and have been doing much of it via tele-health. The big changer is not the mode of communication, however, but the de-emphasis on episodic care. If we view tele-health simply as another way to do an office visit, we miss the boat. The idea is to give care in smaller increments, in bits and pieces along the continuum of the patient’s care. An example is the daily spreadsheet values I get from about a number of my patients with their blood sugar and/or blood pressure readings. This is care, but it is not something that could be codified. EMR once seemed to me to be a game-changer, to organize data and make it more efficient, but instead of changing the system it was changed by the system and became a pernicious tool to increase data and decrease efficiency. In the same way, tele-health won’t be transformational unless the system underlying it is fundamentally changed from one dependent on the problem/procedure based care (which is inherently episodic care) to one where efficiency and prevention is truly valued and rewarded. I can see how to do that in my practice (because I am paid by my patients, not third parties), but I don’t quite believe a very sick system could rearrange a payment structure and become more efficient. In my 20+ years of practice I am not sure I’ve ever seen that actually happen.

  5. So, another medical licensure process. Are the legislators who are currently practicing medicine without a license going to be required to obtain a medical license too?

  6. $42 BILLION market for telehealth visits by smartphone? Honestly, where do you get numbers like this?

  7. Tele-medicine is a relatively low-tech technology offered by many, many players. It isn’t particularly new. It isn’t glamorous. It can’t claim to be Google. It’s not going to make anybody a billionaire. Yet it appears to work. And there many, many potential applications. Home visits. Follow ups. Information sessions. Prevention. Etc. Etc.

    If I were opening my own practice now, I would seriously consider having a skype and video lines where patients can talk to a nurse and front office staff can handle patient intake and review paperwork / orders via screen share.

    In five years, this will be the standard.

  8. Outcomes? Missed diagnoses? Adverse events? Fraud? Upcoding? Visuals or auditory? You mean doctors will get paid for talking to patients on the telephone? Licensure in all states?

  9. We’ve been told forever in California that practicing medicine requires the patient to be in your presence and that you need to do an appropriate examination. This was why they forbad charging for internet consultations. Are these rules going to be relaxed?