Limited reimbursement hinders telehealth adoption

Limited reimbursement is getting in the way of providers adopting telehealth broadly, and most respondents to a new survey said fewer than half of their tele-visits were reimbursed.

Reimbursement was far and away the most frequently cited barrier to expanding telehealth in a new survey of the 114 chief information officers, IT directors, telehealth managers and others by the College of Healthcare Information Management Executives and KLAS. Fifty-nine percent of respondents said reimbursement was getting in the way, followed by cost and resources at 34%, and patient and provider awareness and education at 25%.

"I was not surprised by seeing reimbursement come up as an issue," said Leslie Krigstein, CHIME's vice president of congressional affairs. "Offering telehealth because patients seem to be accepting of it and enjoying the offering is one thing, but if you don't have the dollars to be making these investments, that's going to be a challenge."

There is federal legislation in the works to reimburse telehealth visits better, and the survey's authors believe the care model will see increased adoption in the future.

But federal legislation has been piecemeal: In September, the Senate unanimously passed the CHRONIC Care Act of 2017, which would broaden the range of telehealth visits covered by Medicare, and the U.S. House of Representatives' Ways and Means Committee approved the Increasing Telehealth Access in Medicare Act. In early October, the House Energy and Commerce Committee cleared the Furthering Access to Stroke Telemedicine Act of 2017.

But currently, "the lack of reimbursement has made it difficult for organizations to make a business case for expanding telehealth," the authors wrote.

In the face of that outlook, 58% of those surveyed said they plan on expanding service lines and specialties, and just 26% said they plan on expanding patient access or the number of patients.

While the survey's authors suggested that all types of telehealth—scheduled visits, specialty consultation and on-demand visits—should have technology that allows providers to document the encounters in patients' electronic health records, 70% of those surveyed said there is no integration, and just 14% said there is bidirectional integration.

"Provider organizations want to be able to access EMR data from within their (virtual care platform), but interfaces are missing, and many organizations are frustrated with what it costs to achieve any sort of integration," according to the KLAS vendor report associated with the survey.

A few EHR vendors, like Epic Systems Corp., offer telehealth from within their systems. Epic is the second-most popular platform for scheduled telehealth visits, beat by American Well, which is also the most popular for on-demand visits, according to KLAS.

Being able to transfer data is key for the success of telehealth, said Ron Emerson, a former board member of the American Telemedicine Association and global director of strategic and partner development for telemedicine vendor AMD Global Telemedicine. But even if a telehealth platform is integrated into one hospital's EHR, that doesn't necessarily mean the data will be able to travel beyond that EHR, since interoperability challenges among EHRs still remain.

"If those EHRs across that larger geographic area don't talk to each other, there's really limited benefit," he said.

EHR integration is beneficial not just in terms of getting patient data to move, he said, but also in terms of workflow.

"Organizations want their clinicians to be able to use the same interface in their day-to-day interactions," he said. "We want to provide telehealth with healthcare professionals mimicking their everyday experience, just not with the patient in the same room."