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Reimbursement Misconceptions Trending in Telehealth Services

By Vera Gruessner

- The healthcare industry has been evolving significantly over the last several years, as meaningful use requirements under the Medicare and Medicaid EHR Incentive Programs have led to the adoption of EHR technology, health information exchange systems and patient portals. Along with these technologies, telemedicine tools and telehealth services have been truly innovative and advanced virtual patient visits along with diagnostics and treatment for more minor conditions.

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Nathaniel Lacktman, partner at Foley & Lardner and head of the firm’s telehealth and telemedicine practice, conducted a survey on how healthcare providers view the use of telemedicine tools throughout the country. To learn more about the survey, spoke with Lacktman about some telehealth trends uncovered.

mHealthIntelligence: What are some of the most interesting or most important trends in telemedicine that you uncovered in your survey?

Lacktman: Although the survey identified widespread enthusiasm among hospital executives for the opportunities telehealth can offer, it simultaneously revealed a lack of understanding on the full scope of payment sources available to fund telehealth services. 

Many providers lament a perceived lack of funding for telehealth services, but I disagree.  A singular focus on reimbursement is too narrow.  When you expand your perspective from government-paid fee-for-service to include the broader concept of payment and revenue, telehealth shines as a revenue-generating opportunity.

READ MORE: Blue Cross Blue Shield of GA Offers Maternity Telehealth Program What are some of the biggest challenges that providers are encountering when developing telemedicine programs?

Lacktman: Buy-in from senior leadership is important because they may not have had the telehealth business case clearly articulated to them.  They need to take the general concepts of telehealth and work with some to apply it to their particular service lines and business model.  Take the technology and tailor its use to your specific needs, be it hospital, health system, or provider group.  Like any informed business decision, leadership must be shown a clear pathway to how telehealth can realize the goals of their organization.

A second challenge we see with telehealth entrepreneurs is managing scope.  Some of our clients are so excited about the telehealth opportunities and the multitude of models and approaches, their head is almost on a swivel.  They have a huge list of service lines and offerings queued up and they want to map out their entire virtual care or population health program in one swoop.  Instead, the more efficient approach may be to sketch it out generally and tackle one project at a time to start securing successes and building momentum in the marketplace.

A third challenge is a tenor of fear or uncertainty because providers look at telehealth as something uncharted, risky or dangerous.  Providers should not be fearful of regulatory complexity or change.  Do not make lists of ‘the top 10 telehealth risks that keep you awake at night.’  Providers and entrepreneurs should be kept awake at night not out of fear but out of excitement for the opportunities they can harness with telehealth.  Various business models have been developed and there are ways to implement telehealth across the country and the world in a manner that is compliant with the laws and regulations. What healthcare policy changes would you suggest for either state governments or the federal government to implement in order to properly reimburse medical facilities that use telehealth services?

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Lacktman: I would identify two on the federal level and one on the state level.  The most direct way the federal government can influence this issue is through the Medicare program.  There has been federal legislation introduced to expand Medicare coverage of telehealth services.  One change the federal government might consider to make telehealth services more available in the Medicare program is to eliminate the originating site requirement.

Currently, a Medicare beneficiary must be at a qualifying originating site (not his or her home or workplace) in order for Medicare to cover telehealth services.  Because the present definition of originating site is limited to certain healthcare facilities, changing the current Medicare telehealth coverage rules can better address primary care needs.

The second Medicare coverage change that would increase access is eliminating the requirement that the beneficiary reside in a healthcare professional shortage area or rural tract.  There are people who need access to healthcare who live in metropolitan areas like New York City or Detroit.  People seeking access to care live in rural and urban environments alike.

On the state side, we would like to see more states adopting laws to have commercial health insurers cover telehealth services to the same extent they currently cover in-person services.  Those commercial (non-government) dollars will help drive more development in telehealth through private sector activity. What steps should healthcare providers struggling with current policies take to adopt telehealth programs at their facility?

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Lacktman: They should connect with those people who have already done it and are doing it.  There are many different partnerships available and symbiotic relationships in the telehealth space.  Some companies specialize in providing a telehealth platform, and they partner with hospitals so the hospital does not need to build a program of its own.  Other hospitals want to build their own telehealth offerings, so they use videoconferencing vendors or lease telehealth kiosks, or simply program it themselves.  The options are many, and providers should feel confident to embrace these new and innovative ways of delivering care.


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