The evolution of telehealth

The Evolution of Telehealth July, 2014

Telehealth Uptake and Challenges Telehealth is defined as the combined use of medical practice, medical devices, and communication technology to monitor health conditions. Telehealth breaks the traditional model of face-to-face interactions in a brick and-mortar facility and extends the possibility of healthcare to a virtual setting. This enables possibilities of care in rural, developing and highcost care areas. The demand for telehealth is being driven by significant trends in healthcare, population, uptake in technology, cost-focus by government, and increasing consumerism. At the same time, decreased reimbursements, increased availability of healthcare, and a shortage of physicians are lowering the barriers to telehealth adoption. Telehealth is especially helpful in managing the chronic conditions of those aged 65 and older, a growing age-group of the overall population, due to high levels of cardiovascular diseases, diabetes, cancer, and obesity. One of the most important benefits of telehealth is in the lowering of costs as measured by reductions in hospitalizations, readmissions, and length of stays.

In the U.S., there are currently about 200 telemedicine networks, with 3,500 service sites and nearly 1 million patients are currently using remote cardiac monitors1. In 2011, the Veterans Health Administration delivered over 300,000 remote consultations using telemedicine1.

Telehealth Adoption Drivers: Currently, 42% of U.S. acute-care hospitals have telehealth capabilities, according to a 2012 survey from the American Hospital Association (AHA). Hospitals more likely to have telehealth capabilities are teaching hospitals, those equipped with additional advanced medical technology, those that are members of a larger system, and those that are nonprofit institutions. Based on AHA’s survey of 2,891 hospitals the following factors had the most influence on whether a hospital implemented a telehealth program: IT capabilities: No significant association was found between whether a hospital had an electronic health record system and whether it had a telehealth program. However, hospitals with greater technological capabilities, as measured by the presence of a cardiac intensive care unit, were more likely than others to have adopted telehealth.

Rurality: The survey found population density to be inversely associated with telehealth adoption, and hospitals in less competitive markets were approximately 50% more likely to have a telehealth program.

State policies: The survey suggests state laws and regulations regarding telehealth had the strongest influence on adoption. State policies that required private payers to reimburse for telehealth services to the same extent as face-to-face services made hospitals more likely to adopt telehealth.

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American Telemedicine Association: Telemedicine Frequently Asked Questions (FAQs)

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Conversely, state policies that required out-of-state providers to have special licenses when delivering telehealth services to Medicaid patients made hospitals less likely to adopt telehealth.

Telehealth Reimbursement Challenges: A recent study2 determined that it is often more difficult for providers to be reimbursed for telemedicine services because payers treat these claims differently versus in-person claims, for the following reasons:  Billing codes are different for telemedicine and in-person care  Denials are greater for telemedicine than in-person care  Documentation requirements are different for telemedicine  Preauthorization is needed for telemedicine, but not for in-person care  Providers often must have preferred provider status for telemedicine  Telemedicine care often must be subject to case review before services can be rendered

Telehealth Success Stories: UMass Memorial Medical Center3: A tele-ICU program at UMass Memorial Medical Center was able to reduce ICU mortality by 19.6%, hospital mortality by 13.2%, average ICU length of stay by 29.7%, and average hospital length of stay by 26.3%. Additionally, the hospital was able to care for 11% more patients annually while reducing the average cost per case by more than $5,000. The capital cost of the tele-ICU system, $7.1 million, was recovered in less than one year.

Ministry Saint Clare's Hospital3: Five years after the hospital implemented its collaborative teleICU program, the hospital reported results below Acute Physiology and Chronic Health Evaluation Scores in the following areas: ICU mortality (33 percent better than predictions), hospital mortality (26 percent better than predictions) and ventilator days (40 percent better than predictions). The hospital also found the presence of the tele-ICU system made it easier to recruit physicians, as the program helped reduce night and weekend calls while maintaining high quality of care for patients.

Telehealth Outlook: While telehealth has potential, personal provider-to-patient interactions cannot be replaced.

However, telehealth is coming of age as an effective measure that can leverage new, affordable technology with the potential to deliver convenient, effective care to patients and make healthcare affordable and increase care outreach.

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Private Payer Telehealth Reimbursement in the United States, October, 2014: Nina M. Antoniotti ET AL Becker’s Hospital Review: 3 Hospitals That Have Seen Positive Results From Tele-ICU Programs, January 4, 2014

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