Overcoming The Telehealth Reimbursement Hurdle

By Ken Congdon, editor in chief, Health IT Outcomes

Six weeks ago, I wrote a column titled Telehealth's Untapped Potential, which outlined that while telehealth technologies offer some compelling benefits to the healthcare community, they aren't being adopted en masse due to reimbursement, liability, and HIPAA concerns. New data emerged last week that supports this assertion. Taking The Pulse, U.S. Manhattan's annual market research study of 2,041 practicing physicians, revealed that only 7% of U.S. physicians use online videoconferencing to communicate with their patients. While videoconferencing represents just one aspect of telehealth, it still is a remarkably small percentage given the geographic and efficiency implications of the technology. For example, videoconferencing can erase geographic boundaries between doctors and patients, giving seriously ill individuals in underserved rural areas access to top specialists. The technology can also help physicians see more patients more efficiently and expand their patient base without the overhead associated with office-only visits. This will be key in managing newly insured patients under healthcare reform.

Proposed Models For Sustaining Telehealth
While some physicians resist telehealth because they feel video consultations place limitations on the physical exam, the biggest obstacle to adoption continues to be that most insurance companies don't cover electronic communications with patients. This issue, in particular, was addressed last week at an Institute for Health Technology Transformation (iHT²) Health IT Summit in Fort Lauderdale, FL.

Scott Simmons, director of telehealth at the University of Miami School of Medicine, and James Bolling, director of medical imaging at Mayo Clinic were key speakers at the event and shared their methods sustaining telehealth services without relying on insurance reimbursements.

Bolling indicates that Mayo Clinic has four models for delivering telehealth. The first is the loss-leader approach, which anticipates that revenue will be generated from the technology in the form of "downstream services" such as critical care and surgeries. The clinic also generates revenue via some fee-for-service reimbursement, contracts with businesses and schools, and a Web portal for self-insured companies that offer employee health services.

The University of Miami School of Medicine sustains telehealth services in a similar fashion. Instead of relying on insurance reimbursements, the university provides telemedicine services through annual contracts with community hospitals and physician practices. The university also collaborates with the department of family medicine to treat children at six schools in Miami-Dade County who would not otherwise have access to urgent care, or even a school nurse.

The approaches leveraged by Mayo Clinic and the University of Miami School of Medicine may also help you justify an investment in telehealth. Simmons also suggests that patients are becoming more willing to pay for telehealth services out of their own pocket, particularly for their children, because of the convenience these services provide. In any case, the message delivered at the summit was to seek out creative ways to invest in telehealth technologies today instead of waiting for insurance reimbursement models that may never come to fruition. It's the best way for your facility, your patients, and the industry as a whole, to begin reaping the benefits from the technology.