Making Inroads into Telehealth: How One “Sub-Sector” of Healthcare Continues to Evolve (Part 1) | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

Making Inroads into Telehealth: How One “Sub-Sector” of Healthcare Continues to Evolve (Part 1)

June 13, 2018
by Rajiv Leventhal
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One industry expert feels strongly in a healthcare future in which telehealth is simply “health”

Last September, the U.S. Senate unanimously passed the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017, bipartisan legislation that expands telehealth services for chronic care patients in Medicare. As Healthcare Informatics reported at the time, the legislation’s overarching goal is to transform how Medicare works for seniors who suffer from chronic illnesses by including provisions such as expanding access to telehealth services.

Indeed, currently, there are several restrictions regarding reimbursement for telehealth services under Medicare, such as patients may only be located at certain clinical sites or within certain rural areas, and only Medicare-defined physicians and practitioners can provide telehealth services. The bill, which received favorable response from health IT stakeholders, is just one example of various recent and forthcoming policies and regulations that will make telehealth more mainstream and “open up” reimbursement avenues for providers, says Sean Sullivan, an attorney in the healthcare practice group of Atlanta-based law firm Alston & Bird.

Sullivan notes that there are lots of different telehealth policies that fall into a few different buckets.  For one, there is a “licensure obstacle,” in that every state has their own licensure requirements. Generally, the servicing physician has to be licensed in the state where the patient is located. “So you can’t just have a telemedicine company that has 25 doctors sitting in a bunker somewhere in some city, calling patients and taking care of patients all over the U.S.,” he says. “Each patient might be in different states and each physician might only be licensed in one or a few states. And it gets really difficult when you try to have a large-scale telemedicine platform because you have to have coverage and licensures for all the states you are covering. It’s the main barrier right now,” he says.

Sean Sullivan

As far as breaking down those barriers, Sullivan points to the Interstate Medical Licensure Compact, an initiative which just recently officially began accepting applications from qualified physicians who wish to obtain multiple licenses from participating states. Currently, 18 states have adopted the Compact and eight additional states and the District of Columbia have introduced legislation in support of a pathway for license portability.

“That’s a huge relief,” Sullivan attests, speaking to the Compact. “It’s been fairly slow, though it is picking up momentum. But it is still not a one-sized-fits-all solution; doctors can’t sign up and get licensed in every state, but they can certainly apply to all the states where they think they will serve,” he says. And that brings up another key question, says Sullivan: Is there a different standard of care throughout different states and is it even necessary to have that state-by-state licensure?

Indeed, licensing providers across state lines has long been a challenge. Clinicians who want to treat patients in another state have historically had to apply for and pay for licenses in those states, a costly and time-consuming process. Some state boards have sought to prevent or limit the expansion of telehealth, citing patient safety concerns.

For Sullivan, state-by-state variances simply do not make a lot of sense. “A person with a cold, broken bone or any illness in Alabama is probably going to have the same issues and be treated the same way as if he or she was in Oregon. But the main obstacle is that these individual state medical boards want to and need to have a feeling of control. And it’s also a source of revenue in getting those individual licenses from each physician,” he explains.

What’s more, telehealth practitioners have also long been prevented from being able to treat patients until they have established an in-person patient-doctor relationship. But now, in almost every state, that relationship can be created via telemedicine, with Texas being one of the last holdouts for this particular issue.

Still, there continues to exist a confusing landscape of state laws and regulations. Sullivan notes that every state decides on how they the physician-patient relationship can be established, how telemedicine will be treated, whether or not consent is required, what might be required within that consent, what the limitations might be for providing prescriptions, and what the limitations might be for providing licensures.

Nonetheless, Sullivan believes that current and future regulations and policies will help remove some of these barriers, and that telehealth roadblocks will continue to dissipate each year. This will open up telehealth to service new areas—not just rural areas, he says. “Ultimately, all of us will be seeking to get healthcare and technology will simply be a part of it. Telehealth now is its own industry, but the end goal is that healthcare will include telehealth and the ‘tele’ part will go away. But more legislation ends to happen, as well as more regulation and guidance from CMS [the Centers for Medicare & Medicaid Services].”

Sullivan does believe in one key factor that will continue to push the sub-sector forward, however: hospital buy-in. To this end, he says most of his clients are hospitals that are either affiliated with physician groups or have them as subsidiaries. These hospitals are setting up telehealth programs where a big or medium-sized hospital will reach out to smaller hospital and provide telehealth specialist services through their physician groups, he explains. “They may have a subsidiary physician group that has specialists in neuroscience, orthopedics or some other specialty that smaller hospitals might not have available, so they will contract with the bigger hospitals who are putting together telemedicine platforms,” Sullivan explains. That enables the small organizations to keep the patients at those locations. “It can be a lifeline for them,” he adds.

And on the reimbursement front, Sullivan acknowledges that providers are quite frustrated as they want to make sure they are getting paid for the services they provide. But in Sullivan’s point of view, physicians are thinking about the reimbursement challenge in the wrong way. “I try to get them to think about reimbursement not as the top priority, but instead to think about telemedicine as improving quality and improving access to healthcare for people who can’t access it. Then, ultimately, if you get those things in place, the reimbursement will flow. If you are doing things right, healthcare in the U.S. will get better and you will get your reimbursement,” he says.

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Making Care Connections Happen: How Intermountain Healthcare is Moving the Needle on Virtual Care

August 14, 2018
by Rajiv Leventhal
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Treating patients locally, rather than making them travel hundreds of miles for care, was a core driver for Intermountain’s new virtual care initiative

In March, Salt Lake City, Utah-based Intermountain Healthcare announced the launch of one of the nation’s largest virtual hospital services, bringing together 35 telehealth programs and more than 500 caregivers to enable patients to receive remote medical care.

The virtual hospital, called Intermountain Connect Care Pro, provides basic medical care as well as advanced services, such as stroke evaluation, mental health counseling, intensive care, and newborn critical care. “While it doesn’t replace the need for on-site caregivers, it supplements existing staff and provides specialized services in rural communities where those types of medical care usually aren’t readily available,” officials said in the March announcement.

Michael Phillips, M.D., Intermountain’s chief of clinical and outreach services, says that a core reason why the health system went in this “virtual” direction was because its leaders saw the evolving healthcare landscape and wanted to get out in front of it. “Our thought process behind this was that the world has changed from the days where you can only take care of people who [physically] make it to you. But literally every person on the planet is pretty much within the distance of a cell tower now. So we feel people should be able to benefit from [remote] care,” says Phillips.

Offering an example of how these services work in the clinical setting, Intermountain officials brought up the instance of an infant at a southern Utah hospital who was being supported via Connect Care Pro services and received a critical care consultation that allowed the sick baby to stay in that facility instead of being transferred to a newborn intensive care unit (ICU) in Salt Lake City. This single avoided transfer would have cost over $18,000 dollars. The parents of this baby were able to remain in their community, surrounded by their support system, instead of traveling what would have amounted to 400 miles and seven hours round-trip every time they wanted to see their baby, noted officials.

Indeed, as Phillips puts it, when most rural hospitals think about big health systems, their vision is a helicopter scooping in and flying away from the rural facility with its complicated patient. “But we believe that many of those patients can be treated locally, and there are clear benefits to that. First off, it’s better for the patient—having their family separated by 200 miles to drive to a major medical center is not good for their care and doesn’t tallow for a good support system. If they can be treated locally, they should be,” he attests.

As of now, notes Phillips, Intermountain’s virtual care services—inclusive of the Connect Care Pro, which is a direct provider-to-provider service and Connect Care, which is a direct-to-consumer service—covers all of the health system’s hospitals and another nine facilities outside of the system. “We are really covering more than 30 ICUs in all, and we have a stroke service, a neonatal resuscitation service, and [other services]. Our tele-ICU services are covering a few hundred beds with this process,” Phillips explains.

Michael Phillips, M.D.

So far, some of the top results from deploying the virtual services across Intermountain have included reduced length-of-stay, decreased ER and urgent care visits, and improved mortality rates, notes Phillips. What’s more, Connect Care leaders wanted to make sure that clinicians were performing in a telehealth visit with similar antibiotic stewardship than if they were seeing the patient in person. “We don’t want the answer just to be that we talked to you on phone, so we will write you a prescription for an antibiotic; we wanted the [prescribing process] to be as rigorous as it would be in person,” he says.

Although virtual health services are certainly catching on more at health systems these days, some physicians who are used to traditional care delivery are apprehensive. At Intermountain, Phillips offers, “Providers have taken to [Connect Care] well. There is a bit of self-selection for the kinds of people who are comfortable with doing this kind of work and who are good at communicating over this medium. But I think [telehealth] will come to virtually everyone in medicine because for a lot of conditions, it’s simply a more efficient way to deliver care,” he says.

To be clear, Phillips does not believe that in-person visits will “go away” by any stretch, but that it is quite difficult to have extensive, expert coverage at every hospital and physician’s office. “But we can certainly bring that expert in with a telehealth format, virtually everywhere,” Phillips notes. “Yes, cultural changes will need to take place, and I would say that the technology is the easy part. Culture is the challenging part,” he adds.

Phillips also contends that issues around the payment portion of telehealth visits—which has sparked much discussion in healthcare and health IT circles over the years—will continue to present challenges to providers, particularly those that still operate primarily in fee-for-service environments. “We have a large at-risk population here, so the payment part might be less of an issue for us because telehealth works better in a [value]-based model than a fee-for-service one. But these are typical barriers everyone is trying to figure out. In an at-risk model, [telehealth] is efficient and if you’re not worrying about having a fee-for-service payment for each individual episode, it becomes less of a concern,” Phillips says.

In the end, Intermountain clinical and IT leaders believe that virtual care is an efficient way to provide healthcare, Phillips offers. “The technology is meant to make all the folks inside our system more productive. If you look at larger sectors in the economy, there’s only two I can think of in which the workers have not become more productive: medicine and education. And that’s about embracing technology,” he says.

Phillips believes that the cost of healthcare is largely based around how productive an organization’s workers are. Indeed, if 70 percent of the costs are “people,” there’s a need to make sure that this area is well invested so that “we can keep costs affordable for people who need to get healthcare,” he says. “You can have the best healthcare in the world but if people can’t afford it, it doesn’t do you any good. We want as many people as possible to lead healthy lives.”

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CVS Health’s MinuteClinic Launches New Telehealth Offering

August 9, 2018
by Rajiv Leventhal
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CVS’ MinuteClinic, the company’s retail medical clinic, is rolling out a new telehealth healthcare offering for patients with minor illnesses and injuries, skin conditions and other wellness needs.

The MinuteClinic video visits, a telehealth offering, will provide patients with access to healthcare services 24 hours a day, seven days a week from their mobile device, CVS officials said in an announcement this week.

In recent years, MinuteClinic has been testing telehealth as a method of increasing access to care. During the initial phase of testing, a CVS Health study found that 95 percent of patients who opted to receive a telehealth visit were highly satisfied with the quality of care they received. In the same study, 95 percent of patients were satisfied with the convenience of using the telehealth service and the overall telehealth experience. Those results led the company to develop the expanded virtual care offering being launched this week, officials proclaimed.

Working collaboratively with telehealth company Teladoc, and leveraging its technology platform, patients can receive care via a MinuteClinic video visit, initiated through the CVS Pharmacy app. Officials noted that a video visit can be used to care for patients ages two years and up who are seeking treatment for a minor illness, minor injury, or a skin condition. Each patient will complete a health questionnaire, then be matched to a board-certified health care provider licensed in their state, who will review the completed questionnaire with the patient’s medical history, and proceed with the video-enabled visit.

During a MinuteClinic Video Visit, the provider will assess the patient’s condition and determine the appropriate course of treatment, and if an in-person follow up visit with a provider is needed. A MinuteClinic Video Visit costs $59.

“We’re excited to be able to bring this innovative care option to patients,” Troyen A. Brennan, M.D., executive vice president and chief medical officer of CVS Health, said in a statement. “Through this new telehealth offering, patients

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Physicians Still Reluctant to Embrace Virtual Tech, Survey Finds

July 19, 2018
by Rajiv Leventhal
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While consumers and physicians agree that virtual healthcare holds great promise for transforming care delivery, physicians still remain reluctant to embrace the technologies, according to a new Deloitte Center for Health Solutions survey.

Physicians are specifically worried about reimbursement, privacy and other issues, according to the research, which included surveys of both consumers and providers.

The surveys found that a majority of consumers (64 percent) and physicians (66 percent) cited improved patient access as the top benefit of virtual care. About half of physicians surveyed agreed that virtual care supports the goals of patient-centricity, including improved patient satisfaction (52 percent agree) and staying connected with patients and their caregivers (45 percent agree).

However, physicians’ enthusiasm wanes when it comes to using virtual care in their practices today. While 57 percent of consumers favor video-based visits, only 14 percent of physicians surveyed have the capability today, and just 18 percent of the remainder plan to add this capability.

Lack of reimbursement, along with complex licensing requirements and high cost technologies are among the key causes of physician reluctance, the research found. However, changing reimbursement models may be a catalyst for virtual care adoption. The physician survey also found that clinicians worry about medical errors (36 percent) and data security and privacy (33 percent) associated with virtual care. 

One step in the right direction could be a very recent proposed rule from the Centers for Medicare & Medicaid Services (CMS), which included recommended changes to how physicians would be reimbursed for telehealth services. The CMS proposal has so far brought a mix of enthusiasm and concerns from groups advocating for greater usage of telehealth.

 “Changes in health care reimbursement models, combined with growing consumer demand, are driving health systems to embrace virtual care, but they are struggling to get physicians on board,”. Ken Abrams, M.D., managing director, Deloitte Consulting LLP, said in a statement. “However, getting buy-in from physicians may not be as difficult as organizations might expect: most physicians who have tried the technologies associated with virtual care feel good about them. It’s important to help physicians understand how virtual care improves care quality and lessens patient or caregiver burden.”

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