- Healthcare providers looking to mainstream their telehealth programs are making one big mistake: They’re putting telehealth on a pedestal.
“To some extent we have been held to a higher standard than traditional healthcare,” said Elizabeth A. Krupinski, PhD, an Emory University professor and former American Telemedicine Association president. “Now we’re trying to prove somehow that we’re better than traditional medicine.”
That may eventually be the case, said the Associate Director of Evaluation for the Arizona Telemedicine Program and Director of the Southwest Telehealth Resource Center (SWTRC). But in doing so, telehealth advocates are separating telemedicine from the regular practice of medicine, rather than pointing out that this platform is another service line that shouldn’t be replacing anything.
In essence, she said, they’re making telehealth harder to justify than it should be.
“It’s still up to us at the grass roots level to get out there and promote telemedicine,” she added.
Krupinski was the opening keynote speaker at this week’s Northeast Telehealth Resource Center (NETRC) conference at the University of Massachusetts in Amherst, a two-day workshop for healthcare providers in the nine-state Northeast region and one of several such conferences held each year across the country.
Like its brethren scattered across the country, this conference served to showcase telehealth programs throughout the region, highlighting the fact that more than half of the nation’s health systems now offer some telehealth service and roughly 80 percent of those who don’t expect to jump on that bandwagon in the near future.
Examples include York Hospital in southern Maine, which recently launched a direct-to-consumer platform and is looking to partner with local school districts; the North Country Telehealth Partnership, which is rolling out projects across remote northern New York; Northwell Health, New York’s largest health system, which has dozens of telemedicine and telehealth programs up and running throughout the state’s heavily populated southern regions; Connecticut-based Community Health Center, credited with launching the nation’s first successful eConsult program for Medicare populations; and the Massachusetts-based Spaulding Rehabilitation Network, which sees remote monitoring and post-acute rehabilitation as a necessity to compete with other providers.
Krupinski said healthcare providers are “barreling ahead” with telehealth and telemedicine projects of varying shapes and sizes because they see these programs as care delivery platforms to help clinicians and patients, not bold new concepts designed to change the future of healthcare.
To that end, she said studies on the value of telemedicine like the Government Accountability Office report issued in April aren’t breaking any new ground - they’re simply telling providers what they already know. And studies that focus on the accuracy of telemedicine aren’t helpful because no one has ever studied “the accuracy of traditional healthcare.”
Garrett Spargo, principal investigator for the Alaska-based National Telehealth Technology Assessment Resource Center – one of the two national clearinghouses in the 14-center telehealth resource center network – said health systems need to take charge of telehealth and make it their own.
An ideal example, he said, is direct-to-consumer telehealth, which “wasn’t even … on our radar a few years ago.” Now it’s a blossoming market, led by American Well, Teladoc, MDLive and dozens of other companies.
Spargo pointed out that hospitals and doctors’ offices once held an advantage over the direct-to-consumer market because they could conduct in-person examinations and labs – two services not available in a virtual visit. But vendors are now forging partnerships with those labs for on-demand tests, and wireless diagnostic tools have become sophisticated enough that a remote doctor can now conduct exams with those digital devices in the home setting.
With these advances, health systems are now playing catch-up, and are looking for ways to compete in the direct-to-consumer market.
Nathaniel M. Lacktman, a partner with Foley & Lardner LLP and one of the nation’s leading telehealth attorneys, said healthcare providers are also starting to see the value in “medical economics.” They’re realizing that federal reimbursement for telehealth and telemedicine is a long and complex process, so they’re finding other avenues to ROI.
“There are revenue opportunities” outside of reimbursement, he said, such as business with self-funded health plans and private payers who will negotiate with providers to support a new telehealth program.
Another example, he said, is school-based telehealth. Some school districts receive state funding based on a formula that includes attendance and test results. A telehealth program that reduces absenteeism and improves morale and test results (as well as one that reduces staff sick days and cuts down on the cost of substitute teachers) thereby has value to the school district, which can negotiate a contract for that program.
“You need to think bigger about these things,” Lacktman said. “There are a lot of moving parts.”
While Congress is moving toward legislation that would open the door to more telehealth programs and reimbursement, and while states are slowly inching toward telehealth payment and service parity and interstate licensure, Krupinski said the healthcare industry has another reason to invest in telehealth: it’s starting to see systematic reviews and meta-analyses that prove telemedicine’s value.
Health systems and organizations like the Department of Veterans’ Affairs, she said, are beginning to publish the results of randomized, multi-state, multi-system studies that prove that telehealth and telemedicine can deliver clinical outcomes, reduce wasteful spending and overcome access issues for underserved populations.
“They’re absolutely huge,” she said. And they, in turn, will lead to better telehealth policies.
Healthcare providers are also getting support from the ATA, which has published roughly 20 sets of evidence-based practice guidelines for such platforms as telemental health and telestroke. Groups like the ATA and the Consortium of Telehealth Resource Centers are designed to offer resources and guidance to telehealth programs, whether in the planning stages or already established.
In her keynote, Krupinski told attendees of the NETRC conference to forge ahead with telehealth and telemedicine programs. Don’t bother trying to prove that telehealth is better than traditional healthcare, she said, because one isn’t trying to replace the other.
Telehealth, she said, isn’t trying to re-invent the wheel; it just makes the wheel run more smoothly.