Telehealth expansion needs payment, coverage policy advances

Like many industries, healthcare is at a crossroads. One critical decision facing practitioners, especially those of us who operate major healthcare systems, is whether to invest more in our bricks-and-mortar operations or increase funding for cutting-edge telehealth information technology solutions.

At Broward Health in Florida, my staff and I ask ourselves constantly: Which path do we take?

The answer is both. While there is no future in which the face-to-face relationship between a patient and doctor does not exist—we will always need facilities—telemedicine's potential is not only blossoming, it's flourishing, even in disciplines that require the closest interactions between patients and doctors. To expand access to care, save patients precious time and money, and improve the quality of care, we all have to think more about telemedicine.

So must the state and federal policymakers who regulate us.

Five years ago, perhaps even to most healthcare providers, telemedicine meant nothing more than sitting in your primary-care doctor's office teleconferencing with a specialty-care physician whose practice was miles away. When I first attended the Healthcare Information and Management Systems Society annual conference 10 years ago, there were a few vendors offering telemedicine products. Today, thousands of telemedicine vendors attend the annual gathering.

Telemedicine is much more than e-medical records and video chats; technology is now a vital tool in some of the practice areas thought to be the most hands-on.

For example, telepsychiatry is on the rise. Perhaps no doctor-physician relationship is more intimate than the one between patient and psychiatrist or psychologist, but one of the barriers to accessing mental healthcare for some Americans is the simple notion of sitting face to face with a stranger, pouring out emotions. Telepsychiatry may eliminate that anxiety for some patients—and provide them a path to the quality mental healthcare they so badly need, but might not have sought otherwise.

With the persistent shortage of healthcare practitioners in the U.S., hospitals have also begun to use telemedicine for intensive-care patient management. Tele-intensive-care units allow highly trained critical-care teams to remotely monitor patients in several locations at once. Tele-ICUs can improve patient outcomes, reduce mortality and generate cost savings for patients and hospitals—welcome outcomes in a care area that's not only the costliest, but the one with the highest mortality rate.

Even surgery has gone virtual. Using robots they control remotely, physicians now operate on patients from thousands of miles away. The first transcontinental surgery was completed 14 years ago. Today, we can envision a future where a top pediatric surgeon in the U.S. can operate remotely on a sick child in the most far-flung, poorest parts of the world.

In a decade or two, we could all be “doctors without borders.”

However, to make that happen, government policies must encourage rather than inhibit healthcare technology.

According to a May 2015 American Telemedicine Association report, issues surrounding payment and coverage are one of the biggest barriers to telemedicine adoption. Only five states, according to the ATA, have the necessary policies in place to “accommodate” telemedicine adoption. Also, states can still choose whether to cover telemedicine under Medicaid. According to a July 2015 report by the Center for Connected Health Policy, three states still do not reimburse for live video telehealth; only 16 state Medicaid programs reimburse for remote patient monitoring; and 21 states do not offer a transmission or facility fee when telehealth is used.

Also, federal law, along with several state laws, does not yet require private insurers to provide coverage for telehealth services.

This bias against telehealth is ironic given the fact that the U.S. military has long been on the cutting edge of technology-based medicine. On the battlefield, regulations and reimbursement policies do not matter. What matters is saving lives.

Outside the battlefield, state and federal lawmakers of course must write reasonable regulations that ensure the welfare of patients. However, telemedicine is safe, effective and improves access to quality care, even in the disciplines that traditionally have required face-to-face interaction.

Our state and federal reimbursement policies simply have not advanced like telemedicine. Antiquated rules prevent doctors from improving and saving lives. It's time for policymakers to update our laws to account for the balance that American healthcare providers are struggling to achieve every day.