Are we at an inflection point in terms of telehealth in U.S. healthcare? The policy, business, operational, clinical, technological, and IT aspects of telehealth’s moment were discussed broadly in a panel discussion on July 22 at the Sheraton Downtown Denver, during a session at the Health IT Summit in Denver, sponsored by the Institute for Health Technology Transformation (iHT2—a sister organization to Healthcare Informatics under the Vendome Group LLC corporate umbrella.
The session entitled “Telehealth: Colorado and Beyond,” was moderated by Heather Haugen, PhD., Instructor and Co-Director of Health Information Technology, University of Colorado, and its additional participants were Peter Kung, system vice president, virtual Health, SCL Health (Broomfield, Colo.); Samantha Lippolis, telehealth manager, Centura Health (Denver); Kate Kiefert, state HIT coordinator for the State of Colorado; and Debbie Voyles, director of clinical operations, telehealth, at Colorado Access (a Denver-based health plan serving the Medicaid and underserved populations).
panelists Haugen, Kung, Lippolis, Kiefert, and Voyles discuss
telehealth at iHT2-Denver
“Let’s start with some of the changes in opportunities in legislation that have come our way,” Haugen said. “Legislation was passed in May expanding access to telehealth in Colorado. Can you tell us about that?”
Lippolis of Centura Health said, “We had been working for legislation matching federal reimbursement. If a patient is located in a rural area, then commercial payers were required to reimburse for that. Working this year in the legislature, we were able to get that updated. So as of Jan. 1 2017, all commercial payers will be required to reimburse for telehealth services, and the definition has been broadened beyond the historical understanding of it. It’s opened up to urban telehealth, so you can say, would you like to come back here to see your cardiologist, our primary care office, or drive through traffic to see the cardiologist in person? That makes a huge difference for us. It’s very difficult to roll out telehealth in very segmented, rural locations only. We still have the carve-out of Medicare, but this makes a huge difference.”
“This is a really significant breakthrough. What does it mean for patients?” she asked.
SCL Health’s Kung, noting a show of hands of audience members polled on whether they were involved in expanding telehealth in their organizations, said, “It was very encouraging that 40 percent of this audience raised their hands saying that they were involved in this. Kaufman Hall has said this would grow from $20 billion to $40-50 billion a year. We’re moving away from proof of concept and piloting, around telehealth and virtual care. We’re reducing readmissions. And hospitals are going to say, this is actually a growth initiative, strategic to objectives. Sustainable, scalable model will be based on if it’s good for the patient, good for the organization, and good for the community. And I think many hospital organizations will be willing to take the risk and provide better quality at lower cost.”
Kiefert, of the state of Colorado, noted that “The 1029 legislation removed the barriers of location and specific provider and cost—and at Children’s Hospital, which is a significant referral center from several states—a pediatrician can see the patient in Montana and the surgeon can see the incisions from a surgery remotely, without having to bring that child patient back, 10 hours away. So it’s really modernizing and broadening what telehealth can do.”
“Yes, that parity in payment is something we’ve been looking for,” said Haugen. “Now, nationally… a lot of us have been frustrated by a lack of reciprocity across state lines. Nationally, what things are going on?”
Colorado Access’s Voyles said, “You reference cross-state licensing—if you think about the impact that that can have—the VA has that now, and it’s huge. If you look at the analogy of having a driver’s license, and you’re licensed in a particular state, but you’re allowed to drive in other states, if you know the rules. I learned the hard way that in Hawaii, you can’t make a u-turn unless there’s a sign posted saying you can. I was driving there on a Texas license. So I think cross-state licensing will give patients access to the best care possible anywhere.”
Kiefert explained to the audience that Colorado’s Department of Regulatory Affairs (DORA) is in the process of preparing to change rules and guidelines that had been “in conflict with each other,” and that had been barriers to expanding telehealth efforts. DORA as an agency holds a majority of the professional boards in healthcare in Colorado, she noted; it supports the 29 medical professional boards, of which five are mental health medical professional boards. “There are rules and guidelines for all healthcare professionals, and they had rules that were in conflict with each other,” she added. “So you can have legislation removing barriers and providing for payment parity, but they’ve been working through establishing the provider-patient relationship—can you do that remotely? And how can you establish the protocols for telehealth. Some of the language in the rules had been interpreted very conservatively. So they’ve been working on this, and receiving open comments, so they’ll be providing recommendations on this.” In fact, she reported, DORA is expected to produce a set of recommendations in this area in August.