Healthcare Providers Moving Forward with Telehealth, Despite Reimbursement, Cost Concerns | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

Healthcare Providers Moving Forward with Telehealth, Despite Reimbursement, Cost Concerns

October 10, 2017
by Heather Landi
| Reprints
Click To View Gallery

Almost 60 percent of healthcare provider organizations with telehealth programs plan to expand the number of service lines or specialties served through telehealth systems and report patient convenience among the top benefits of telehealth, according to a study released by KLAS Research and the College of Healthcare Information Management Executives (CHIME).

Orem, Utah-based KLAS, a market research firm, and CHIME surveyed 104 healthcare organizations with telehealth programs to assess how healthcare organizations currently use telehealth solutions and identify barriers to its adoption. Overall, 59 percent of respondents cited improved patient access as one benefit of telehealth services, followed by improved clinical outcomes (35 percent) and lower costs (29 percent).

The study found healthcare organizations used their virtual care platform vendor in one or more of three primary visit types. More than half (56 percent) of respondents report using virtual care platforms for tele-specialty consultations to improve the clinical outcomes of patients by increasing their access to needed specialists. Thirty-eight percent of respondents are using their virtual care platform for scheduled/patient-focused visits to increase patient access by allowing patients to schedule and conduct a clinical visit virtually. And, 36 percent are using telehealth for on-demand/consumer-focused visits to decrease the costs for patients and providers by dealing with urgent/nonemergency medical needs of patients on-demand.

With the continued adoption of these technologies, organizations are now beginning to realize some of the long-expected benefits. Increased access for patients, improved clinical outcomes, and a reduction in costs were all cited by multiple respondents as benefits that have been attained from their telehealth solution, the report authors wrote.

What’s more, the survey findings indicate that healthcare organizations using telehealth have realized unique benefits to each of the specific visit types. For instance, with scheduled/patient-focused visits, 68 percent of respondents reported increased overall patient satisfaction. Close to one-third of respondents reported improved clinical outcomes and one-third reported lower costs. With on-demand/consumer-focused visits, respondents cited augmented brand awareness leading to increases in market share as one benefit. And, with tele-specialty consultations, survey respondents reported better clinical outcomes driven primarily by telestroke technology. 

As mentioned above, 58 percent of survey respondents plan to expand the service lines or specialties served through telehealth solutions and 26 percent plan to increase patient access to telehealth services.

However, the study found that telehealth is still in the early stages of adoption and many of the healthcare organizations with telehealth programs that participated in the study raised questions about cost, reimbursement, available technology, value, the patient experience and integration. In addition, promises of integration from telehealth vendors have not been realized. When integration is achieved by providers, it is most often unidirectional, the report authors wrote.

About half of the study respondents listed reimbursement as a limitation, noting that some payers have been slow to reimburse telehealth visits and/or reimburse at rates that are lower than face-to-face care. Most said integration between their electronic medical record and virtual care platform vendor was nonexistent or unidirectional.

Reimbursements are the biggest constraint on the successful expansion of telehealth technologies, and insurance companies, Medicare/Medicaid, and accountable care organizations (ACOs) have been slow to reimburse virtual visits. Though some provider organizations have received reimbursements, these often amount to less than is needed to cover the cost of the services provided. Unincentivized providers are a natural consequence of this since providers can earn more for in-person visits. The lack of reimbursement has made it difficult for organizations to make a business case for expanding telehealth solutions,” the report authors.

The report authors note that almost all states have legislation pending that would help alleviate some of the reimbursement challenges faced today. As legislation improves, difficulties surrounding reimbursement will likely fade, leading to increased adoption of telehealth solutions.

“Telehealth offers a great opportunity to enhance the lives of patients by making healthcare accessible to them wherever they may be,” Russell P. Branzell, CEO and president of CHIME, said in a statement. “Our members are advocates for improving patients’ lives through innovations like telehealth. But it needs to be carefully implemented to meet its potential and we still face headwinds with reimbursement and integration issues.”

“Telehealth holds enormous promise,” Adam Gale, president of KLAS, said in a prepared statement. “However, the underlying technology needs to evolve faster. In particular, integration of telehealth with provider EMR’s is still at a primitive level. Vendors need to step up in terms of technology and improved support.”

 

 

2018 Seattle Health IT Summit

Renowned leaders in U.S. and North American healthcare gather throughout the year to present important information and share insights at the Healthcare Informatics Health IT Summits.

October 22 - 23, 2018 | Seattle


/news-item/telemedicine/healthcare-providers-moving-forward-telehealth-despite-reimbursement-cost
/article/telemedicine/making-care-connections-happen-how-intermountain-healthcare-moving-needle

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

August 14, 2018
by Rajiv Leventhal
| Reprints
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.”


More From Healthcare Informatics

/news-item/telemedicine/cvs-health-s-minuteclinic-launches-new-telehealth-offering

CVS Health’s MinuteClinic Launches New Telehealth Offering

August 9, 2018
by Rajiv Leventhal
| Reprints

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

Related Insights For: Telemedicine

/news-item/telemedicine/physicians-still-reluctant-embrace-virtual-tech-survey-finds

Physicians Still Reluctant to Embrace Virtual Tech, Survey Finds

July 19, 2018
by Rajiv Leventhal
| Reprints

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.”

See more on Telemedicine ...