By David Raths
Rob Sprang, director of Kentucky Telecare and co-project manager of the Kentucky TeleHealth Network, Lexington, Ky., may be forgiven for being a bit skeptical of any declaration that 2013 is going to be the year of telehealth.
“Every year we seem to say this is the year of telehealth,” he says. “In the early days there were technology challenges. We were trying to do things beyond the scope of the technology. But the technology now has outpaced the application of it. The technology is not what is holding us back now.”
So what is the problem with telehealth? “Reimbursement, reimbursement and reimbursement,” Sprang says.
Traditionally, Medicare and Medicaid have very narrowly defined which types of telemedicine and telehealth services they would pay for. Reimbursement did not extend to any county that had a large urban center, for instance.
But Sprang is optimistic that healthcare reform may change the way payers, including the federal government, look at telehealth. “Moving from volume-based reimbursement to a model that features incentives for value—that excites me more than anything,” he says. “If we can get patients to see the right doctor at the right time, we can save a lot of money.”
Some other signs that telehealth is on the rise? The ATA Annual Meeting and Trade Show, already the world’s largest exposition for telemedicine and telehealth technologies, is projected to grow even larger in 2013, expanding 30 percent in both floor size and the number of exhibitors.
Through multiple grant programs, the federal government continues to support telemedicine programs linking health centers throughout the country. For instance, the Centers for Medicare and Medicaid Innovation grant awardees include seven telehealth projects.
Some provider organizations also see accountable care as a driver of telehealth in 2013. Wesley Valdes, M.D., medical director of telehealth at the Utah-based Intermountain Healthcare, sees it as one of the pillars of shared accountability, which is Intermountain’s effort to include the patient as a stakeholder. “As we move from fee for service to a capitated model, it requires a different strategic approach,” he says. “We are putting a telehealth platform in 2,500 patient rooms in 23 hospitals. That is a radical departure from how telehealth has been done previously.”
Valdes offers an example of a physician who does rounds at two hospitals 10 miles apart. If he is at hospital A and needs to do a consultation at hospital B, he can do that remotely. “It may not mean he doesn’t do an in-person visit with that patient later,” he stresses. “But he will appreciate the acuity. He can actually see a wound.”
Almost any hospital service can be done remotely, Valdes adds. “For instance, we can have interpreters or case managers available virtually in any room. We can load-balance our resources,” he says.
Intermountain is also launching an eVisit online service in which patients can do online video chats. “We created our own platform rather than using a vendor solution,” he says. “We didn’t want to use a customization of their process. We wanted to make it match our clinical workflow.”
From a pilot project in 2012, eVisit is expanding to 25,000 Intermountain employees in the first quarter of 2013.
As they have grown over the last few years, state telehealth networks have started to find niches in which they can provide valuable services such as image sharing. With the Colorado Telehealth Network (CTN) subsidizing access to high-capacity broadband connections, it now takes three or four minutes for rural hospitals’ to transmit images to urban hospitals compared to two hours or more previously, says Debby Farreau, program director for CTN. “That makes a huge difference in trauma situations,” she says.
CTN has worked with a group of Colorado hospital CIOs on the possibility of a shared image exchange in a private cloud, working with vendor GNAX Health. The basic idea is that if the hospitals choose to create cloud-based vendor-neutral archives in the same partitioned cloud, then with the proper permissions, patient identification and security, image sharing could be handled in that cloud, explained Toria Thompson, a consultant to CTN. The telehealth network also has partnered with the two state health information exchanges to use their master patient index solutions and develop integrations between the HIEs and the image repository. The hospital CIOs, CMIOs and radiology teams were involved in the vendor selection process and are currently working through the contract process before going live.
Ed Bostick, CTN’s executive director, says that beyond getting the image-sharing system up and running, the organization’s focus in 2013 is to get more safety net facilities in Colorado to join the network and to explain to its members how telehealth might help them develop closer relationships with patients in the coming era of accountable care.
Roy Schoenberg, M.D., CEO of the Boston-based American Well Systems, a telehealth solutions provider, sees several things happening that will “liberate” telehealth and bring greater clarity to the marketplace. Previously telehealth was confused with telemedicine, which involves clinicians using telecommunications—for instance a rural hospital taking advantage of the skills of a radiology team at an academic medical center. Telehealth, brings consumers into the equation and the patients have access whether at home, a retail setting or in the workplace, he says. It got a bad name a decade ago when Internet pharmacies started popping up and prescribing drugs improperly. There was a backlash and legislatures created laws to shut them down.
“But in 2012 we saw a breath of fresh air and a recognition that under the right circumstances and following the same rules doctors use in a clinic setting, the same licensing and documentation requirements, telehealth can live up to its promise,” Schoenberg says.
Fifteen states have now passed legislation that specifically authorizes reimbursement for telehealth services. At the federal level, a comprehensive telehealth reimbursement bill introduced at the very end of the 112th Congress will be re-introduced this year, he believes.
Payers such as WellPoint have recognized telehealth is critical in terms of their level of patient services, he adds. “It is like having a live doctor in your medicine cabinet, and that changes the offering with a very tangible benefit,” Schoenberg says. “Employers who have a stake in the financial cost of employees’ health also are seeing it as a productivity gain. All of these activities are exciting and it really feels like the pieces of the puzzle are coming together. It is very much going mainstream.”