As each state’s medical board defines the standard of care that physicians must provide to patients, these state medical boards have the power to decide whether physicians can provide telehealth services and the conditions under which they can provide it. Without proper guidance from the board, physicians become widely exposed to incurring risk, which leads to their reluctance to provide telehealth services.
In some states, physicians are required to establish physician-patient relationship through in-person encounters only, at least for the first of their patient-physician visits. This is based on the presumed difference in quality of care provided from the virtual encounter compared to an in-person one. These kinds of policies impede the adoption of telehealth. Patients are not allowed to consult with doctors they only met virtually. This limits the capability of physicians to provide healthcare services to remote locations and largely negates the purpose with which telehealth is developed.
Meanwhile, other states have crafted policies that affirmatively allow providers to establish a physician-patient relationship using telehealth. States such as West Virginia, Louisiana, Mississippi, and Texas, have provided provisions for the applications of telehealth albeit using different standards for practice within each of these states.
But this is not an isolated case: all states set their own laws and regulations; there are no national standards for telehealth. This lack of uniformity creates a serious legal obstacle for physicians who wish to practice medicine in multiple states.
States do not even have a consistent definition of what is considered as telehealth. For example, some states may require telehealth to involve real-time communication whereas others allow asynchronous messaging between patients and providers. Or one state may consider telehealth to include phone-based interactions while another requires interactive video.
These definitions may not even be internally consistent, as some states may have one definition for the general population and another set of rules for their Medicaid program. This complexity means that telehealth providers must research and adhere to different rules depending on where their patients are located and who is their insurer. Creating a consistent definition for telehealth among all states is a necessary step towards unlocking telehealth services that can be scaled nationally.
Castro, Miller, and Nager in a report for the Information Technology and Innovation Foundation entitled “Unlocking the Potential of Physician-to-Patient Telehealth Services” (May 2014) wrote:
Another major barrier to the widespread adoption of telehealth has been lack of consistent reimbursement policies for telehealth services. Reimbursement policies vary from state to state. Each state determines whether its Medicaid program will reimburse for particular telehealth services and under what conditions. For example, some states only reimburse for telehealth services in certain geographic regions, such as rural or underserved areas within the state. Others restrict patients from obtaining telehealth services in their home, instead requiring them to be at a clinic. Overall, every state’s Medicaid program except Iowa, Massachusetts, New Hampshire, New Jersey, and Rhode Island reimburses at least some telehealth services, such as live video encounters. However, only seven states (Alaska, Arkansas, Hawaii, Illinois, Minnesota, New Mexico, and Vermont) allow Medicaid reimbursements for “store-and-forward” services such as tele-dermatology, which happen asynchronously. Only ten states (Alabama, Alaska, Colorado, Kansas, Louisiana, Minnesota, New York, Texas, Utah, and Washington) offer Medicaid reimbursement for remote patient monitoring in the home. States also can determine whether private insurers will reimburse for telehealth services. Twenty-one states have passed laws requiring private insurers to cover some form of telehealth. For example, Montana and Virginia require insurers to cover telehealth services and reimburse at the same rate they would for in-person services. Other states, like Georgia, New Mexico, and Texas only require coverage, but do not require that the reimbursement rate be equal to in-person services. Reimbursement policies have an impact on telehealth adoption: hospitals are more likely to adopt telehealth if they are in states requiring private payers to reimburse telehealth services at the same rate as in-person services.
Clearly, there is a lack of consistency between states’ finding policies for telehealthcare delivery, and absence of a straightforward, uniform policy for funding may pose a significant obstacle to this technology’s adoption.
Telehealth is a welcome development amid a chronic disease crisis in our country, where the continuous rise of the population affected with chronic illnesses is aggravating the already dire situation and causing the cost of health care services to skyrocket.
Sadly, the health industry in its current structure is leading us down an unsustainable path. If not addressed properly, the average American will lose the ability to access health care. This loss will result in even greater social and economic costs – from further stress on the health care sector, to diminished workers’ productivity, to the overall deterioration of all Americans’ quality of life.
With the rise of telehealth, we are seeing an opportunity to save the healthcare industry. Through the use of technologies available to the average American, health care services particularly for chronic illnesses could become less costly and of higher quality. Indeed, patterns across states show that telehealth has not only improved health care delivery but the way our society approaches health.
To encourage widespread adoption of telehealth, the following critical factors must be considered or addressed. Leading these factors is the lack of proper network infrastructures to address the demand for telehealth technologies. Without the proper infrastructure, no telehealth program will completely succeed. Stakeholders have recognized this and are taking steps to address it. Another consideration is financing sources for sustainable growth. Like other technologies, telehealth needs financing in order to continuously innovate. Several financing options, both public and private, are present.
Training of both practitioners and patients as well as capacity-building is also necessary. It is a big help that the technologies used in telehealth are mostly commercially available and are now deeply ingrained in the lives of people (i.e.., Internet, mobile communications, television, etc.). This familiarity with many everyday telecommunications tools used by all strata of society by people who have attained many different levels of education may auger in an easy transition for many people to use telehealth technologies for their healthcare needs.
Finally, policymakers must also do their share in order to encourage the use of telehealth. This move includes promoting a more standardized approach to telehealth programs, developing state policies that advance rather than impede telehealth applications, and deciding on ways to make healthcare reimbursement and coverage applicable to telehealth services.
There is a lot of work to do before we can fully reap the benefits of telehealth. But with the proper steps taken by all stakeholders, a society with improved access to quality health care through telehealthcare is a vision we can all look forward to and work on together to realize its development.
New opportunities are emerging for companies to provide industry solutions as a result of The Obamacare Health Care Act (ACA). Some of these companies are:
HExL
Richard A. Kimball, Jr. is CEO and Founder of HExL, a company that enables independent primary physicians to transform their practices financially and clinically to drive better health outcomes, lower costs and improve accessibility. We offer a turnkey technology enabled service enabling primary care physicians to enter into value based reimbursement programs and to be paid for keeping patients healthy.
Evolent Health
Frank Williams is CEO and Co-Founder of Evolent. This company provides the integrated technology, tools and team to advance value-based care. Our work begins with the Blueprint, an immediately actionable strategic roadmap that defines target markets, assesses needed clinical and operational capabilities, and is supported by a detailed business case.
Health Care Partners
Kent Thiry is CEO of Health Care Partners, a company that has been committed to developing innovative models of healthcare delivery that improve our patients' quality of life while containing healthcare costs. Our strength is in our steadfast commitment to our guiding principle of coordinated care. Our physicians strive daily to bring the benefits of coordinated care to more than 600,000 managed care patients in California, who represent the diversity of cultures, socioeconomic groups, ages, and health statuses in the communities we serve.
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