How Will the Growth of Telemedicine Impact Patient Care?

AS VARIOUS FACTORS CONTINUE TO INFLUENCE rising health care costs, many stakeholders are examining more creative ways to contain expenses. One way that is gaining traction is the greater utilization of telemedicine. Telemedicine is not a new concept, but in this new era of doing more with less, everything is on the table.

According to the American Telemedicine Association (ATA), telemedicine is the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.

Telemedicine includes a growing variety of applications and services that use 2-way video, email, smart phones, wireless tools, and other forms of telecommunications technology. The use of telemedicine is quickly becoming integrated into the ongoing operations of hospitals, specialty departments, home health agencies, and private physician offices, as well as consumer homes and workplaces.¹

Furthermore, the ATA has historically considered the terms “telemedicine” and “telehealth” to be interchangeable. I often wondered how telemedicine differs from other familiar concepts, such as mobile health (mHealth) or health information technology. According to the ATA, mHealth is a form of telemedicine using wireless devices and cell phone technologies to practice medicine.

Health information technology (HIT), on the other hand, is the “generation and transmission of digital health data, often through an electronic health record.” Generally, HIT is used for administrative functions, while telemedicine is the delivery of an actual clinical service.²

The market size for telemedicine shows potential for future growth. An Ernst & Young Health Care Industry Post titled “Shaping your telehealth strategy,” reported the US telehealth market will grow from $240 million in revenue in 2013 to $1.9 billion in 2018, at an annual growth rate of more than 50%.

This anticipated surge is due in part to the current physician shortage and an expanded patient base under the Patient Protection and Affordable Care Act. Also vital in the move toward telehealth are efforts to put consumers at the center of their own health care to maximize the power of technology innovations for virtual care, where patients can get the care they need, where and when they need it.³

Policymakers have been very active in this issue area. Although telemedicine policies exist for the Centers for Medicare & Medicaid Services, the interest of Congress in telemedicine has increased over the last 2 years, with 5 bills currently pending:

• HR 2725, the 21st Century Care for Military and Veterans Act, is sponsored by Representative Scott Peters (D-CA) and proposes to expand the use of telehealth under the TRICARE program and in the Department of Veterans Affairs.
• S1549, the Care Planning Act of 2015, is sponsored by Senator Mark Warner (D-VA). The bill seeks to require Medicare coverage for 24-hour access to emergency support in person or via telephone or telemedicine with the individual’s medical record and care plan available to the responder.
• HR 691, the Telehealth Modernization Act of 2015, is sponsored by Representative Doris Matsui (D-CA) and proposes to promote the provision of telehealth by establishing a federal standard for telehealth.
• HR 2948, the Medicare Telehealth Parity Act of 2015, is sponsored by Representative Mike Thompson (D-CA) and proposes to provide for an incremental expansion of telehealth coverage under Medicare.
• HR 2066, the Telehealth Enhancement Act of 2015, is sponsored by Representative Gregg Harper (R-MS) and seeks to promote and expand the application of telehealth under Medicare and other federal health care programs.

On the state level, 29 states and Washington DC have implemented telemedicine coverage laws. In Colorado, HB 1029, the Concerning Coverage Under a Health Benefit Plan For Health Care Services Delivered Through Telemedicine In Any Area Of The State, was enacted this year.

Under current law, plans issued, amended, or renewed in this state cannot require in-person coverage under the plan for individuals residing in a county with 150,000 or fewer residents if the care can be appropriately delivered through telemedicine and the county has the technology necessary for care delivery via telemedicine.

Starting January 1, 2016, the law removes the population restrictions and precludes a plan from requiring in-person care delivery when telemedicine is appropriate, regardless of the geographic location of the health care provider and the recipient of care.

• A provider need not demonstrate that a barrier to in-person care exists for coverage of telemedicine under a health benefit plan to apply. Additionally, carriers are required to perform the following: Must reimburse providers who deliver care through telemedicine on the same basis that the carrier is responsible for coverage of services delivered in person;
• Cannot charge deductible, co-payment, or coinsurance amounts that are not equally imposed on all terms and services covered under the health benefit plan; and
• Cannot impose an annual or lifetime dollar maximum that applies separately to telemedicine services.

Indiana’s telemedicine law requires telemedicine services coverage under private insurance delivered by use of interactive audio, video, or other electronic media. Additionally, a health care provider may not be required to obtain separate additional written health care consent for the provision of telemedicine services.

New Hampshire’s law clarifies when it is appropriate to use telemedicine in practitioner-patient medical circumstances and states that except for practitioners treating patients in community mental health programs, a practitioner shall not prescribe certain controlled drugs via telemedicine.

In contrast, Texas’ telemedicine movement has been up and down throughout this year. While there were laws in place allowing telemedicine, including a new one passed this year allowing children enrolled in Medicaid to meet remotely with a doctor while under the supervision of a school nurse, the Texas Medical Board voted earlier this year to restrict telemedicine by requiring doctors to establish a relationship with patients before giving telemedicine services.

This ruling seemed ironic since Texas is home to Teladoc, which is among the most successful telehealth providers in the United States. However, a federal district court ruled against the board by enjoining it from implementing its potentially chilling rule.

Additionally, the payer community is increasing its coverage of telemedicine. With new parity laws trending statewide, reimbursement is starting to become similar across services received via telemedicine versus services received at a traditional site of care.

Humana is piloting an integrated and coordinated telehealth program for some of its Medicare Advantage beneficiaries in Arizona, since the state has several areas where there is limited access to care, which causes increased emergency room utilization.

The pilot is also being offered in 14 other states and, if successful, will be rolled out into other markets throughout 2017. UnitedHealthcare is another large market player expanding coverage for virtual physician visits that give beneficiaries enrolled in self-funded employer health plans secure online access to a physician via mobile phone, tablet, or computer 24 hours a day.

Coverage for virtual care provider visits is now available to self-funded employer customers and will expand to UnitedHealthcare employer-sponsored and individual plan participants in 2016, giving more people expanded in-network options. The company is partnering with Doctor on Demand, Optum’s NowClinic and American Well’s Amwell to provide video-based virtual visits in 47 states and Washington, DC.⁴

In conclusion, telemedicine holds both promise and a few lingering questions. Due to the slower congressional climate, issues such as standard of practice, licensure, and payment parity will likely be handled faster on the state level. This may, in fact, be the preferred option, since more patients are increasingly relying on technology to manage their health care.

While some may be adverse to change, it is hard to dispute the potential cost savings telemedicine offers compared with a more costly visit to either nearby urgent cares or the emergency room. SPT

References

• American Telemedicine Association What is Telemedicine? http://www.americantelemed.org/about-telemedicine/what-is-telemedicine#.VkEvo_mrTIU
• American Telemedicine Association FAQs http://www.americantelemed.org/about-telemedicine/faqs#.VkEyqvmrTIU
• Ernst & Young Health Care Industry Post Shaping your telehealth strategy http://www.ey.com/Publication/vwLUAssets/EY-shaping-your-telehealth-strategy/$FILE/EY-shaping-your-telehealth-strategy.pdf
• UnitedHealthcare Covers Virtual Care Physician Visits, Expanding Consumers’ Access to Affordable Health Care Options; April 30, 2015 http://www.uhc.com/news-room/2015-news-release-archive/unitedhealthcare-covers-virtual-care-physician-visits

About the Author

RON LANTON III, ESQ is president of True North Political Solutions, LLC. He has over 20 combined years of government affairs and legal experience. This includes activities on the municipal, state, and federal levels of government. Most recently, he worked for a pharmaceutical wholesaler where he created and oversaw the company’s government affairs department, served as their exclusive lobbyist, and advocated for the company’s various health care customers. Prior to that, Ron worked at a government affairs consulting firm in Arlington, Virginia, where he focused on health care, energy, commerce, and transportation issues. He has also clerked for a federal magistrate, was appointed as a municipal commissioner on environmental issues, and has served as consultant to Wall Street firms on financial issues. He has been a featured industry speaker on issues such as pharmaceutical safety and health care cost containment. Ron earned his juris doctor from The Ohio State University Moritz College of Law and a bachelor of arts from Miami University of Ohio. He is also a “40 Under 40” award recipient. He is admitted to practice law in New York, Illinois, and the District of Columbia.