When it comes to adding any new service, especially telehealth, the first question many of you have relates to reimbursement. If you read last week's article you discovered the need, some of the benefits and how easily telehealth is to implement. Today we're going to discuss reimbursement, key drivers and what you should look for in telehealth technology.
As far as telehealth is concerned, Medicare Part B covers certain services, like office visits and consultations that are provided with these two stipulations:
- You must be using an interactive 2-way telecommunications system with real-time audio and video; and
- That it is provided by a doctor or certain other health care provider who isn’t at the patient’s location. Now these rules are relaxed a bit for rural areas to actually include getting them while in a facility or office due to physician shortages so the patient can come into the center and then have a telehealth visit with perhaps a specialist that isn’t located at the center.
So all of your patients with Part B are covered. Also Medicare Advantage enrollees are covered and commercial plans have added telemedicine as a supplemental benefit with relation to the Medicare population which is a pretty positive sign for the future of telemedicine. When it comes to Medicaid - Medicaid differs from Medicare in that its policies vary from state to state; each state has flexibility to determine how it will reimburse for telehealth, and many have gone well beyond the scope of Medicare. Each year, additional states expand their scope of reimbursement, and new proposals are filed constantly. So it would be important for you to follow up on reimbursement at a state level.
Now when it comes to Commercial Payers or private insurers, they have been the most aggressive in reimbursing for telehealth visits. Most national plans embrace telehealth and have been steadily broadening the coverage they offer which is good news for everyone. It’s good for the patients too because they are benefiting from more choices in how they receive their care. Additionally, many private insurers offer real-time eligibility and claims processing which allows the provider to know prior to starting a telemedicine visit if the patient’s plan will reimburse them for their services.
It’s interesting to note that as of today, 29 states and the district of Columbia have parity laws that mandate commercial payers provide comparable coverage and reimbursement for telemedicine services as in-person services which is great news for providers because it suggests that over time telemedicine will gain parity footing with in-person consultations across the board.
So why are payers so open and welcome to the idea of reimbursing for telehealth? Here’s some of the statistics found in a study published in March of this year by The Rural Broadband Association, which is an organization focusing on building what they call “Smart Rural Communities.” Basically, they comprise programming related to and promoting rural broadband networks and their broadband-enabled applications so rural communities can leverage them to foster innovative economic development, education, healthcare, etc. So the Rural Broadband Association published their research and included a lot of information about the benefits of telemedicine to the rural health community and this is some of that information.
First they identified some nonquantifiable benefits such as access to specialists and the timeliness of care along with overcoming transportation obstacles and improved outcomes overall. Then they took look at some actual benefits that they could quantify and came up with these numbers.
- Travel Expense Savings: $5,718 per medical facility
- Lost Wages Savings; $3,431 per medical facility
- Hospital Cost Savings $20,841 per medical facility
- Increased Local Revenues for Lab Work: From $9,204 to $39,882 per type of procedure, per medical facility
- Increased Local Pharmacy Revenues: from $2,319 to $6,239 per medical facility depending on the specific drug prescribed.
I wanted to take a quick look specifically at the benefit of having greater access to specialists because I found this to be an interesting piece of information. Approximately 15% of the U.S. population lives in rural areas. That is about 46 million Americans. However, only 10% of U.S. Physicians practice in rural areas while the other 90% practice in urban areas. And when you look at specialists, in particular, there are only 40 Rural Specialists for every 10,000 residents while there are more than three times that amount, 134 specialists, for every 10,000 urban residents. Telehealth can have an enormous impact on that number by making it far more easy for rural patients to have a consult with a specialist via video conferencing. And those specialists can have easier access to test results and things like MRIs and CT Scans through store and forward telemedicine. So the challenge isn’t about whether or not it is needed, because clearly there’s a need. It’s become more about adoption.
The Center for Connected Health Policy identified six key drivers of telehealth adoption. These are:
- Policy: both national and state policies that support and promote telehealth which we have seen gain tremendous ground over the past year.
- Technology: new advancements that improve usability and decrease costs. My organization, iSALUS Healthcare, has worked a great deal on this particular piece to the point that we have made it possible to conduct a telehealth visit with just a couple of clicks of the mouse and the monthly cost per provider is less than the cost of a single office visit.
- Financing – which includes government and private payers or accountable care organizations
- Transformation of the Health System by making telehealth a standard practice
- Evidence – of course, more and more research is coming available just like the study by the Rural Broadband Association that was published in March of this year
- And then, finally, Consumer Demand which is ever increasing as patients become aware that it is available. In fact, in a recent poll by American Well, they found that in general, 20% of patients would even be willing to switch doctors in order to be able to have access to telehealth and the number rises drastically when it comes to parents with small children. 78% of those patients would be willing to switch their doctor in order to make use of telehealth.
Now as I wrap all of this up, I want to give you a few key factors that are important to a telehealth system in general. As you’re doing research and looking for the right system, make sure you discuss integration. It will be key for the system to be able to communicate in some fashion with the other technology that you use to manage electronic patient health information. Having a geo-based component is also key. Because you will have patients that utilize telehealth for reasons other than the convenience and timeliness factors. You’ll have patients that are traveling, perhaps, and need to see the doctor due to unexpected illness and your system should be able to identify where the patient is, and then if a prescription is required, you will automatically be able to identify the closest pharmacy and send their prescription to the easiest place for them to get it. So that is important.
You’ll also want to find a system that has the text component which is key to the convenience factor that most patients truly love about telehealth. It takes away the so-called “waiting room obstacle” and allows the patient to receive a text right when the doctor is ready so they can go about their business instead of waiting on the doctor, and then be notified when it’s time to open the app and begin the encounter. And then billing will be key component also. If your EHR and billing software are different, you’ll need to make sure that the telehealth system can communicate properly with the system you use and if any issues are going to arise in that communication so that you’re billing will be seamless and claims can be easily submitted.