If you were to ask someone on the street what they consider the most impactful digital health innovation over the last five years, there’s a good chance their response would be, “telemedicine”. Not only is it easily understood–the value in using digital tools to communicate with a care professional remotely instead of battling traffic for the privilege of waiting an hour only to be told to rest and increase fluid intake isn’t lost on many–versions of telemedicine are actually available and used by patients today.
Oddly, even with its place in the general public’s lexicon, telemedicine utilization is still rather low. According to Deloitte’s 2018 Survey of US Physicians, only 23% of patients have had video visits and just 14% of physicians have video visit capability. While video visits are only one aspect of telemedicine, these numbers make it clear that the technology still has not reached the point of mass adoption and use. Is 2019 the year we see telemedicine take the leap? Join me as I explore a few interesting developments that just might help telemedicine finally cross the technology adoption chasm and usher forth an era of “virtual fist” healthcare.
First–what exactly do we mean when we say “telemedicine”?
*rubs temples in exasperation*
As you might expect, this being healthcare and all, there isn’t one definition of “telemedicine”. A quick search will provide you with hundreds of wonderfully SEO optimized articles outlining the differences between telehealth, telemedicine, telecare, remote patient monitoring…
For the sake of this article (and my sanity), I will let the good folks at The Office of the National Coordinator for Health Information Technology (ONC) define telemedicine (or telehealth) as:
“…the use of electronic information and telecommunications technologies to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration. Technologies include video conferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications.
Telehealth applications include:
- Live (synchronous) video conferencing: a two-way audiovisual link between a patient and a care provider
- Store-and-forward (asynchronous) video conferencing: transmission of a recorded health history to a health practitioner, usually a specialist.
- Remote patient monitoring (RPM): the use of connected electronic tools to record personal health and medical data in one location for review by a provider in another location, usually at a different time.
- Mobile health (mHealth): health care and public health information provided through mobile devices. The information may include general educational information, targeted texts, and notifications about disease outbreaks.
My only tweak to the ONC’s definition would be to ignore the focus on “video conferencing”. The rise of chatbots, virtual assistants, and messaging platforms makes focusing on video rather limiting and not representative of the evolution of technology solutions to serve the purpose of telemedicine (“to support and promote long-distance clinical health care, patient and professional health-related education, public health and health administration”).
Alright. Now that we are all on the same page, let’s explore what new developments make 2019 feel like the year telemedicine utilization takes a leap.
CMS expanding reimbursable telemedicine and remote patient monitoring services
A study published in Health Affairs found that Medicare and Medicaid, the two largest insurance programs administered by the Centers for Medicare & Medicaid Services (CMS), accounted for 59% of revenue for the 5 largest US commercial health insurance companies. As the single largest payer for healthcare in the US, anything CMS does to expand reimbursement for services has an enormous impact. For 2019, CMS has implemented a few changes that promise to have a significant impact on the telemedicine industry.
The original extent of reimbursable telemedicine services by CMS was defined by the incredibly specific and obnoxiously narrow language found in Social Security Act, Section 1834(m). It focused almost entirely on providing care to patients in specific rural areas, limited the types of caregivers that could provide telemedicine services, and required reimbursement rates to be the same as in-person visits.
This definition failed to:
- Acknowledge that patients and providers might prefer telemedicine even when geographical hurdles/ provider shortages don’t exist
- Understand the different workflows and tasks associated with care delivered remotely
- Empower the maximum number of clinical staff to provide care
- Enable provider organizations to leverage technology to provide care at different rates
Thankfully, CMS is creating space to reimburse for additional telemedicine services by differentiating “communication technology-based services” and “remote patient monitoring” from the exceedingly restrictive original definition of “telehealth” services. The primary additions that promise to have the most impact on the adoption and use of telemedicine in 2019 include:
HCPCS code G2010 which outlines reimbursement for “remote evaluation of recorded video and/or images submitted by an established patient”
- Why this is a big deal: Eligible patients are no longer limited to a specific rural area or originating site. Reimburses for asynchronous care delivery! Learn more
HCPCS G2012 which outlines reimbursement for “brief communication technology-based service, e.g. virtual check-in”
- Why this is a big deal: Eligible patients are no longer limited to a specific rural area or originating site. Learn more
CPT Codes 99453, 99454, 99457 which outline reimbursement for “Chronic Care Remote Physiologic Monitoring”
- Why this is a big deal: Reimburses for additional work including initial setup, patient education, device monitoring, and extends eligible care provider definition to include clinical staff. Learn more
HCPCS codes G0513 and G0514 which extend telehealth services related to “beneficiaries with end-stage renal disease (ESRD) receiving home dialysis and beneficiaries with acute stroke”
- Why this is a big deal: Eligible patients are no longer limited to a specific rural area or originating sites. Learn more
Additionally, while not in effect until July 1, 2019, CMS will remove the “originating site geographic requirement for telehealth services targeting treatment of substance use disorder or a co-occurring mental health disorder”. Due to the sheer extent of our current opioid crisis this legislation could realistically double the volume of individuals who have received care via telemedicine and further cement its status as a viable means of care delivery.
While not perfect, these additions show a level of commitment by CMS to further encourage the adoption and use of telemedicine by providers. As with all things healthcare, there are concerns additional bill codes will over complicate things and create an environment where the administrative burden outweighs the benefits but I don’t think that is the case here. I think all of these additions promise to increase the number of patients that receive care via telemedicine moving forward.
Healthcare executives investing in the future
Whereas changes to CMS reimbursement is a very clear driver of increased telemedicine utilization, there are qualitative signs that are equally encouraging. According to a report published by the Center for Connected Medicine and The Health Management Academy, 45% of respondents expect use of telehealth to increase by 10% or more in 2019. The report cites “lack of reimbursement” as the greatest barrier to adoption currently and “integration with clinical workflow and ease of patient triage/ virtual follow up” as the top features when considering a telehealth technology system. Even with these concerns, there are numerous anecdotes by CIOs and CMIOs stating that they plan to invest in telemedicine because they see it as “table stakes” for the future due to the increase in consumer demand and the cost-saving potential if leveraged correctly.
We’ve already covered how CMS is making progress to improve reimbursements. While not perfect, their work to encourage the use of telemedicine seems sincere and we anticipate further improvements in the years to come.
As for integration with clinical workflow and ease of patient triage/ virtual follow up, we know first hand that this functionality is readily available on the market today. We work with dozens of telemedicine providers catering to provider organizations large and small. We’ve proven that a new era of clinical integration is possible through the Redox Platform and are impressed by the capabilities of our partners’ products. Our position as a two-sided network catering to both technology vendors and provider organizations gives us a rare front line perspective and we’re here to tell you–the technology is ready. Functionality, usability, and ease of integration are all available. Just by existing customer growth within the Redox Network, we feel confident that provider fears about integration will subside. You add it all up and it certainly feels like 2019 will be a big year for telemedicine.
How Redox helps
As with all things Redox, we have something for Provider Organizations and Technology Vendors.
If you are a provider organization looking to take advantage of these new reimbursement programs and want to invest in a telemedicine partner for the first time, we’d love to introduce you to some of our partners. If you already have a telemedicine program in place but feel it could be optimized with improved integration we’re here to help as well. Our provider organization team is always available to help you understand what integration is possible through a single connection to the Redox Platform and how you can leverage us to optimize your existing solution for patients and caregivers. If any of these offerings pique your interest, simply send us a message and our team will follow up with you.
For the technology vendors out there, we will be hosting a webinar on Thursday, February 21, 2019, covering how Redox supports Telemedicine and Remote Patient Monitoring workflows with our simple, scalable health data exchange platform. Make sure to RSVP today!