New Bill Proposes Expanded Telehealth Services for Hospitals & Healthcare Providers

Virtual healthcare is a godsend to struggling healthcare systems as they try to offer the right care in the right setting. Every day, these systems face enormous pressure to provide both high-quality and cost-effective healthcare to their communities. Their clinics are filled with scheduled patients, while others wait for a “work in.”

Patients suffering from chronic diseases frequently wait to see a doctor until their conditions are critical. Often when they arrive at emergency departments, they need expensive in-patient treatment, rather than routine preventative care.

Patients with diabetes, for example, are at greater risk of heart disease than the average person. By monitoring cholesterol and lipid levels, prescribing statins and creating a nutrition and exercise plan, however, a healthcare team can help a patient with diabetes stay heart healthy. The alternative – not following a patient's condition closely and waiting for a problem to arise – can lead to expensive, in-patient treatments such as angioplasty, stents or surgery.

Enter virtual healthcare. With an internet connection, a doctor or other healthcare professional can meet with a patient with a minimum of effort. The patient can stay at home or at the office and "attend" the appointment using services similar to Skype. Patients can explain symptoms and discuss lab results with a doctor who is miles away. Remote monitoring devices, such as continuous glucose monitors or cardiac monitors, can deliver information collected during previous days or weeks, better informing the virtual office visit.

For telehealth to make economic sense for hospitals and physicians, however, two changes must be made. The first is obvious – healthcare providers must be reimbursed using new payment models that reward early intervention and follow up. Waivers are currently available for telehealth as part of the Merit-based Incentive Payment System, but payments must adapt to the technological ability to consult in a virtual environment. Payers must determine what care will be reimbursed in a virtual environment.

It's just simple math that paying a fee of $95 per month to monitor a diabetes patient before they have chest pains is more cost effective than paying thousands for stents or heart surgery. Our system must shift from "treatment" to "prevention" of disease. Reimbursing early intervention and efforts to keep a patient healthy will ultimately pay dividends.

U.S. Senators Roger Wicker, R-Miss., and Brian Schatz, D-Hawaii, introduced a new bipartisan measure this summer to expand access to rural telehealth services by allowing non-rural hospitals and health-care providers that service rural areas to make better use of the Federal Communications Commission’s Healthcare Connect Fund. Large organizations designated as non-rural are often the lead centers for telehealth, providing services to rural health-care providers throughout a geographical area. Because the administrative responsibility and expertise required for these efforts is often challenging, larger organizations typically serve as the consortium lead. This new bill would allow these non-rural providers to qualify for the 65 percent health-care provider discount under the HCF so long as the majority of the locations serving patients are in rural areas.

The second factor that must develop is a healthcare system's ability to brand itself and its services through apps and portals that also serve to provide essential clinical and management information about the customer. An effective virtual-care system can accommodate almost 65 percent of the current clinical load with the remaining 35 percent referred to urgent care, primary care physicians or emergency departments. The resulting system has increased clinical capacity while reducing the number of patients seeking treatment in the emergency department. Healthcare systems must develop a brand that attracts patients to their services.

Until we solve governance issues to create a seamless system and reimbursement issues to make the endeavor profitable, we will not see as rapid an adoption of telehealth as is technically possible. Each state has adopted its own guidelines, and they are often contradictory and difficult for multi-state organizations to navigate. Payment models have been slow to evolve, but the healthcare system must change. Virtual healthcare can help us reach the goal of providing the appropriate care in the appropriate setting at an affordable cost.


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Topics: MIPS Healthcare, MACRA Summary

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