Skip to main content
Sister Publication Links
  • ESG: THE NEW IMPERATIVE
Subscribe
  • My Account
  • Login
  • Subscribe
  • News
    • Current News
    • COVID-19
    • Providers
    • Insurance
    • Government
    • Finance
    • Technology
    • Safety & Quality
    • Transformation
    • People
    • Regional News
    • Digital Edition (Web Version)
    • Patients
    • Operations
    • Care Delivery
    • Payment
    • Midwest
    • Northeast
    • South
    • West
  • Digital Health
  • Insights
    • ACA 10 Years After
    • Best Practices
    • Special Reports
    • Innovations
  • Data/Lists
    • Rankings/Lists
    • Interactive Databases
    • Data Points
  • Opinion
    • Bold Moves
    • Breaking Bias
    • Commentaries
    • Letters
    • Vital Signs Blog
    • From the Editor
  • Events & Awards
    • Awards
    • Conferences
    • Galas
    • Virtual Briefings
    • Custom Media Event: ESG Summit
    • Webinars
    • Nominate/Eligibility
    • 100 Most Influential People
    • 50 Most Influential Clinical Executives
    • Best Places to Work in Healthcare
    • Excellence in Governance
    • Health Care Hall of Fame
    • Healthcare Marketing Impact Awards
    • Top 25 Emerging Leaders
    • Top 25 Innovators
    • Diversity in Healthcare
      • - Luminaries
      • - Top 25 Diversity Leaders
      • - Leaders to Watch
    • Women in Healthcare
      • - Luminaries
      • - Top 25 Women Leaders
      • - Women to Watch
    • Leadership Symposium
    • Social Determinants of Health Symposium
    • Transformation Summit
    • Women Leaders in Healthcare Conference
    • Best Places to Work Awards Gala
    • Health Care Hall of Fame Gala
    • Top 25 Diversity Leaders Gala
    • Top 25 Women Leaders Gala
    • - Hospital of the Future
    • - Value Based Care
    • - Supply Chain Revenue Cycle
    • - Hospital at Home
    • - Workplace of the Future
    • - Virtual Health
    • - Future of Healthcare Staffing
  • Multimedia
    • Podcast - Beyond the Byline
    • Sponsored Podcast - Healthcare Insider
    • Video Series - The Check Up
    • Sponsored Video Series - One on One
  • MORE +
    • Advertise
    • Media Kit
    • Newsletters
    • Jobs
    • People on the Move
    • Reprints & Licensing
MENU
Transformation Hub

Where healthcare challenges find solutions

  • Patients
  • Operations
  • Care Delivery
  • Payment
Care Delivery
July 22, 2019 07:00 AM

Virtual visits outside of the hospital fueled telehealth growth

Alex Kacik
  • Tweet
  • Share
  • Share
  • Email
  • More
    Reprints Print

    When a Mount Sinai Health System patient had to go to the emergency department for what turned out to be a stomach virus, Dr. Bruce Darrow followed up with him by video to ensure that it wasn't a heart issue.

    The patient, who had a history of heart problems, felt and looked great two days after he was discharged, the cardiologist and chief medical information officer at New York City-based Mount Sinai said.

    "He did not have to take a half day off of work and could do that from the comfort of his own desk," said Darrow, adding that he was able to verify the patient's medication adherence and check any lingering or new symptoms. "For him, you could argue he had a better visit with a doctor by not going to a doctor."

    These types of virtual visits are becoming much more frequent, new data show. Discharge-related telehealth consultations saw the second-most growth among all commercial insurance claims for telehealth, according to Fair Health, which analyzed its database of 28 billion claims, the largest repository in the country.

    Non-hospital-based telehealth fueled the surge in the burgeoning technology's growth, rising 1,393% from 2014 to 2018, according to Fair Health's new white paper. These types of virtual consultations or remote monitoring that occurs between providers and patients outside of the hospital made up 84% of all telehealth claim lines, compared to 52% in 2014. Most of those encounters were in urban areas.

    Advocates argue that telehealth is poised to bend the cost curve by improving treatment adherence particularly for those with chronic conditions, boosting access and reducing utilization of more expensive care settings.

    "Telehealth can reduce utilization of the ER, which is high cost," said Fair Health President Robin Gelburd. It also may comfort people, knowing they have a more convenient and affordable option, she added.

    But notably, telehealth outside of the hospital is still only being used on average 1 out of every 1,000 visits, or 0.104% of all medical claims, looking at Fair Health's raw data. Use is rapidly expanding but it started from an extremely low baseline of 0.007% in 2014.

    Telehealth overall grew 624% from 0.0192% of all commercial insurance claims in 2014 to 0.1394% in 2018. The most common recipients of telehealth services were individuals ages 31 to 40 and nearly two-thirds were female.

    "What that age cohort is showing is that telehealth is really becoming part of the front lines of primary care," Gelburd said. "And telehealth is providing a means of access to care that may be challenging for someone who may be working full time."

    The top three reasons individuals sought treatment from a provider via non-hospital-based telehealth were acute upper respiratory infections, mood disorders, and anxiety and other nonpsychotic mental disorders.

    "It is sometimes challenging to get behavioral health services to as many patients as would benefit from them," Darrow said. "Being able to bring down barriers to access associated with transportation becomes really valuable."

    Drilling down into telehealth that's used after patients were discharged to monitor treatment adherence, for instance, shows most claims were for individuals age 51 and older.

    The most common condition associated with patients who visited a provider in-person within 15 days of a telehealth session was heart failure.

    For initial valuations, Darrow said he prefers to examine someone in person so he can feel a pulse, listen to the heart and form a connection. But for follow-ups, if the cardiologist needs to check in to potentially adjust medication for high cholesterol or blood pressure and ensure they are using an at-home blood pressure machine correctly, a virtual consultation is often a viable and more convenient option, he said.

    "That would be a use case where the value of a patient spending 45 minutes on a subway and 20 minutes in the waiting room so they can spend six minutes in the office talking to me is somewhat limited," Darrow said.

    For primary-care physicians, Darrow said, it may be entirely suitable to connect via video to check out a rash and determine whether an in-person visit is necessary. Likewise for a surgeon, a follow-up shortly after a patient is discharged might be appropriate to do by video if someone is having an uncomplicated recovery, he said.

    Mount Sinai also digitally consults with other providers, Darrow added, although that practice is not widely utilized across the country, according to Fair Health data.

    Meanwhile, both federal and state governments continue to loosen telehealth reimbursement restrictions.

    "Medicare is starting to recognize the importance of telehealth as are health plans that are including telehealth providers in their network," Gelburd said. "In addition to the technical means to allow these exchanges, the challenges are how do you ensure telehealth encounters are integrated into the total healthcare model to optimize efficiency and reduce redundancies."

    Forty states and Washington, D.C., have adopted substantive policies to expand telehealth coverage and reimbursement since 2017, a related study from the American Telemedicine Association found. Meanwhile, 36 states and D.C. have parity policies that require commercial insurers to cover telehealth and 21 states and D.C. have coverage parity policies for Medicaid. But only 16 states mandate that insurers' payments match in-person visits compared with 28 states for Medicaid.

    Parity laws are an important step in the right direction, but not the full answer, Darrow said. Parity laws say that the insurer has to pay for a telehealth visit, but it doesn't say it has to pay all providers that offer one, he said.

    "Insurers can decide how narrow they want their coverage networks," Darrow said. "The more agreement there is between what services are covered and who covers them between Medicare and Medicaid and commercial insurance, the simpler it will be for doctors to provide this service and for patients to get this service."

    Tags: Care Delivery, This Week in Healthcare, Telehealth, Transformation, Transformation Hub, Digital Health
    Letter
    to the
    Editor

    Send us a letter

    Have an opinion about this story? Click here to submit a Letter to the Editor, and we may publish it in print.

    Recommended for You
    Amazon_sized_getty_i_i_i.jpg
    Amazon expanding Amazon Care with behavioral health
    woman stressed calling
    States prep for 988 mental health hotline's national debut
    Sponsored Content
    Get Newsletters

    Sign up for enewsletters and alerts to receive breaking news and in-depth coverage of healthcare events and trends, as they happen, right to your inbox.

    Subscribe Today
    MH Magazine Cover

    MH magazine offers content that sheds light on healthcare leaders’ complex choices and touch points—from strategy, governance, leadership development and finance to operations, clinical care, and marketing.

    Subscribe
    Connect with Us
    • LinkedIn
    • Twitter
    • Facebook
    • RSS

    Our Mission

    Modern Healthcare empowers industry leaders to succeed by providing unbiased reporting of the news, insights, analysis and data.

    Contact Us

    (877) 812-1581

    Email us

     

    Resources
    • Contact Us
    • Advertise with Us
    • Ad Choices Ad Choices
    • Sitemap
    Editorial Dept
    • Submission Guidelines
    • Code of Ethics
    • Awards
    • About Us
    Legal
    • Terms and Conditions
    • Privacy Policy
    • Privacy Request
    Modern Healthcare
    Copyright © 1996-2022. Crain Communications, Inc. All Rights Reserved.
    • News
      • Current News
      • COVID-19
      • Providers
      • Insurance
      • Government
      • Finance
      • Technology
      • Safety & Quality
      • Transformation
        • Patients
        • Operations
        • Care Delivery
        • Payment
      • People
      • Regional News
        • Midwest
        • Northeast
        • South
        • West
      • Digital Edition (Web Version)
    • Digital Health
    • Insights
      • ACA 10 Years After
      • Best Practices
      • Special Reports
      • Innovations
    • Data/Lists
      • Rankings/Lists
      • Interactive Databases
      • Data Points
    • Opinion
      • Bold Moves
      • Breaking Bias
      • Commentaries
      • Letters
      • Vital Signs Blog
      • From the Editor
    • Events & Awards
      • Awards
        • Nominate/Eligibility
        • 100 Most Influential People
        • 50 Most Influential Clinical Executives
        • Best Places to Work in Healthcare
        • Excellence in Governance
        • Health Care Hall of Fame
        • Healthcare Marketing Impact Awards
        • Top 25 Emerging Leaders
        • Top 25 Innovators
        • Diversity in Healthcare
          • - Luminaries
          • - Top 25 Diversity Leaders
          • - Leaders to Watch
        • Women in Healthcare
          • - Luminaries
          • - Top 25 Women Leaders
          • - Women to Watch
      • Conferences
        • Leadership Symposium
        • Social Determinants of Health Symposium
        • Transformation Summit
        • Women Leaders in Healthcare Conference
      • Galas
        • Best Places to Work Awards Gala
        • Health Care Hall of Fame Gala
        • Top 25 Diversity Leaders Gala
        • Top 25 Women Leaders Gala
      • Virtual Briefings
        • - Hospital of the Future
        • - Value Based Care
        • - Supply Chain Revenue Cycle
        • - Hospital at Home
        • - Workplace of the Future
        • - Virtual Health
        • - Future of Healthcare Staffing
      • Custom Media Event: ESG Summit
      • Webinars
    • Multimedia
      • Podcast - Beyond the Byline
      • Sponsored Podcast - Healthcare Insider
      • Video Series - The Check Up
      • Sponsored Video Series - One on One
    • MORE +
      • Advertise
      • Media Kit
      • Newsletters
      • Jobs
      • People on the Move
      • Reprints & Licensing