Is lack of clarity stunting outpatient telemedicine growth?

HIMSS Analytics

Telemedicine – the practice of transferring medical information via telecommunication technology or specially designed medical devices for the purpose of delivering healthcare services and clinical information – is not new in healthcare. Healthcare delivery organizations have been using this technology for years now. For rural or medically underserved parts of the country, where people do not readily have access to high quality care, telemedicine can serve as an underpinning to the improved health of our population across the nation.

Download a free Snapshot Report of the 2017 Outpatient Telemedicine Essentials Brief Study

Telemedicine is continuing to see growth in the inpatient market. Recent HIMSS Analytics research shows adoption of telemedicine solutions or services has surged since the study was first conducted in 2014 from roughly 54 percent in 2014 to 71 percent in 2017. After consistently growing 3.5 percent annually based on study results, adoption has increased roughly 9 percent since 2016. A large increase shows the continued interest and implementation in the technology.

The outpatient market is a very different story where these still emerging technologies are facing different adoption challenges.

As part of the 2017 Outpatient Telemedicine Essentials Brief study conducted in March and April of 2017, physicians and practice administrators were asked what they would like to see in the future with telemedicine solutions/services technology to help their practices provide and coordinate patient care and improve outcomes?

Answers from this group fell mainly within two categories: reimbursement and liability.

There appears to be a distinct disconnect on these issues within the physician practice community and telemedicine technology vendors as to how they can use telehealth technology and both keep patients safe and be reimbursed by insurance companies.

One respondent noted the need for “greater clarity about rules and regulations related to telemedicine, specifically about reimbursement, liability, and geography (i.e. across state lines when a patient is traveling).”

Another, pointedly asked, “is it safe and reimbursable?”

Still another, with maybe the most telling response of the current outpatient sentiment around telehealth technologies, chimed in with, “If insurance companies take the lead to make reimbursement for telemedicine services as easy as for in-office visits, my practice might move in the telemedicine direction.  If insurance companies have already done so, they have failed to make it clear to me that they want to move in this direction.  At present, any visit that I conduct for which I bill must be a face-to-face in-person visit, and anything shy of that amounts to insurance fraud.  There is no way I am taking a chance on moving in the telemedicine direction until insurance companies indicate how they will value such services.”

This call for clarity is not falling on deaf ears and commercial insurers have taken the driver’s seat.

In October 2016, eleven private insurers issued a public letter to the Congressional Budget Office Director, Keith Hall, urging him to take into account their experience with telemedicine reimbursement when evaluating how the technologies may be accounted for in Medicare coverage.

“We view telemedicine as an important tool in increasing consumer access to high quality, affordable healthcare, improving patient satisfaction and reducing cost. Given recent advances in technology, telemedicine gives customers a new way to be more engaged in their care, and save time and money. Additionally, telemedicine contributes to the value-based care goals of patient engagement, expanded hours for primary care, population health management and care coordination,” they said.

Later in the letter, findings from a 2014 public actuarial study from were included noting that “on average, 83 percent of telehealth visits resolved the clinical issue for which care was being sought via telehealth, requiring no additional follow-up care.”

While certainly an impressive statistic, the full court press of private insurers seems to have not yet moved the needle for Medicare legislators. The lack of clarity from insurers and regulating bodies is a hurdle that telemedicine vendors will face as telemedicine adoption grows.


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