he burgeoning field of telehealth has the potential to solve some of the world’s most significant health care challenges: difficulty accessing care, rising costs, and poor outcomes. While innovation in telehealth is poised to revolutionize the health care industry, I see three fundamental issues blocking its widespread adoption: poor perception, even poorer reimbursement, and outdated infrastructure. Fixing all three could open the door to this positively disruptive approach to health care.
Telehealth is the intersection between technology and health care which enables a range of health care services to be delivered virtually — from a doctor counseling a patient at home on the best way to treat their flu to a rural nurse delivering emergency care to an individual possibly having a stroke under the guidance of an urban neurologist miles away.
Although most people embrace the convenience that telehealth provides, many others believe — erroneously — that virtual doctor visits aren’t as good at delivering high-quality care as in-person visits. According to a recent survey of about 400 medical consumers, respondents felt that the lack of in-person interaction, the absence of a physical exam, and having to use technology were big drawbacks to using telemedicine.
Doctors are also hesitant to jump on the telehealth bandwagon. In one 2017 study, only 30 percent of physicians surveyed reported having previously used telemedicine. The study found that physicians see lack of organizational funding for telehealth equipment, antiquated technology, and insufficient training as barriers to using telemedicine.
Despite the current perception issues, many studies demonstrated that both patients and health care providers benefit from adopting telehealth. The American Heart Association has gone so far as to endorse telehealth as a way to help reduce the significant burden of cardiovascular disease and stroke in the U.S.
There is also widespread lack of awareness about the breadth of services that fall under the umbrella of telehealth. Even in the primary care realm, with which patients are likely most familiar, the options for virtual care are more varied than one might expect. Although telehealth services initially meant a trade-off between familiarity and convenience (patients could “see” a doctor at their convenience, but not one they knew or who knew them), more hospitals, health systems, and medical offices are now offering their patients the ability to virtually see their own doctor for certain conditions. This allows for valuable care continuity on both sides of the equation — doctors know the medical histories of the patients they’re seeing and can make more informed medical decisions, while patients may have more trust in the doctors they know.
Moving forward: By integrating telehealth into existing practices of care, hospitals, health systems, and medical offices can minimize many of the poor perceptions of telehealth held by patients and doctors, especially impersonal or insufficient care. When patients venture into telehealth consultations with physicians they already know and trust, their established goodwill is bound to improve acceptance of this new delivery vehicle for health care.
Inadequate — or nonexistent — reimbursement
With the passing of the Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act in February, federal lawmakers took the first step toward furthering telehealth by allowing Medicare to pay for some telehealth services. Unfortunately, this act only scratches the surface, as Medicare still covers only a relatively tiny portion — namely stroke treatment and dialysis — of the wide variety of virtual services available. When it comes to breaking down the barriers to adopting virtual care and cutting red tape in favor of improving patients’ lives and health, we need a universal approach to reimbursement — equal coverage for in-person and virtual visits.
To put this into perspective, Vitals’ ninth annual report on physician wait times found the average patient waits for nearly 20 minutes once they get to their doctor’s office — and that’s on top of the time they spend traveling to and from the office. That dead time could be eliminated with telehealth. But it won’t happen without universal reimbursement, since physicians are forced to require in-person visits in order to be paid for the care they deliver.
Moving forward: A universal reimbursement model that removes physical proximity to the patient as a factor for physician payment would not only save patients’ time but also allow their doctors to spend less energy worrying about whether they’ll be reimbursed for their services, and put more energy into making the best treatment decisions possible. In cases such as the flu, when it may be in the best interest of the patient’s health, and the health of those around him or her, to avoid journeying to a crowded waiting room, doctors and patients can opt for virtual care without being financially disadvantaged for doing so.
With the health care system still evaluating the role to be played by telehealth, it has not invested what’s needed to make telehealth a reality. Once universal reimbursement is in place, attention will quickly shift to the technological quality of virtual care. Poor connectivity or outdated systems will not be acceptable.
Just as hospitals and health systems struggled to create electronic health records when the Affordable Care Act mandated meaningful use, when the virtual care dam breaks, hospitals, health systems, and medical offices that suddenly have to play catch-up or start from scratch will face major operational challenges. Those that already have telehealth programs in place will want to ensure they’re equipped to handle the scale and quality assurance that regulators and patients will come to expect. Providers need to get ahead of the game now — yet many haven’t.
A 2017 study by Sage Growth Partners, “Defining Telemedicine’s Role: The View from the C-Suite,” revealed that even though telemedicine is growing in importance and investment, hospitals and health systems’ budgets for it are still modest. In the study, two-thirds of health care C-suite respondents said they have annual telehealth budgets of $250,000 or less — about 30 times less, for example, than the $7.6 million the American Hospital Association estimates the average-sized community hospital spends each year. These are interesting statistics considering other research from the American Telemedicine Association showing that the investment in telehealth is worth the risk of upfront costs and will likely save money in the long run on both information technology and administrative costs.
That’s something Medicare has learned. As part of the 1997 Balanced Budget Act, the Congressional Budget Office approved limited telehealth guidelines and, according to the American Heart Association, predicted that Medicare would spend $150 million on telehealth in the first five years of implementation. In fact, it spent only $57 million during that period and then, from 2001 to 2015, Medicare came in a whopping $93 million under budget. Despite the limited investment, the number of Medicare telehealth visits between 2008 and 2014 grew by more than 500 percent, and Medicare saw spending reductions of 8 percent to 13 percent per beneficiary with certain chronic conditions.
If these numbers are any indication, telehealth could be the “missing link” in the health care industry’s efforts to improve health outcomes while managing skyrocketing costs.
Moving forward: With full understanding that it’s easier said than done in today’s health care climate, which has put enormous financial pressure on providers, health care organizations should prioritize investment in telehealth solutions. By making changes to embrace the virtual care revolution while it’s still in its infancy, organizations that provide health care will not only be able to help solve some of their most pressing challenges, including physician shortages, demand for consumer-first solutions, and lack of access, but also reduce their future burden when the rest of the world catches up and consumers and regulators demand that health care follow the lead of other industries in embracing all that technology has to offer.
Telehealth = health care
Industries such as banking, retail, and transportation have managed to make the jump and embrace technology with proven results. It’s time for the health care industry to do the same thing. Showing patients and providers the value of this new approach, increasing access to virtual health care, paying physicians for telehealth services, and upgrading providers’ infrastructure will lay the foundation for a system that will improve the health of all Americans. There’s no time to waste.
Joseph M. DeVivo is the chief executive officer of InTouch Health, a California-based telehealth services company. InTouch Health funded the Sage Growth Partners study mentioned here and approved its publication. The company is a member of the American Telemedicine Association and its founder is a past president of the organization.