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What is Limiting the Widespread Adoption of Telehealth?

By Jennifer Bresnick

- Telehealth has been hailed as the blockbuster technology of the future for decades, but has yet to truly break through into the mainstream healthcare system.  While the industry now has more enabling health IT than ever before, with smartphones in every pocket and Skype on nearly every laptop, there are still a number of barriers to the widespread acceptance and use of remote consults to ease crowded physician schedules and improve access to care.

Licensing and legal restrictions

One of the primary barriers to telehealth is an old-fashioned system of state-based licensing laws.  While the Federation of State Medical Boards (FSMB) is actively pushing to dissolve the artificial borders produced by state-specific physician licensing, many regions of the country will only allow providers to engage in telehealth if the patient is located within the same state.  This limits the effectiveness of telehealth systems designed to connect patients with the top specialists in their field, who may be located at hospitals or clinics across the country, and makes it difficult for telehealth to achieve the necessary scale to be truly effective.

Another legal impediment is the requirement in some states that patients must visit with a primary care provider face-to-face before being allowed to dial in to a video conference or web chat.  This rule is designed to foster better relationships between patients and providers, but may also limit participation for patients who are considering telehealth precisely because they cannot travel to a provider’s office.

Inadequate health IT and broadband internet infrastructure

While it may seem hard to believe for patients and providers used to the tech-savvy comforts of urbanized areas, much of the country still suffers with slow and unreliable internet connections.  In 2013, the FCC announced a $400 million annual investment in rural telemedicine that includes funding to strengthen broadband connections, but states such as Kentucky, Virginia, and Mississippi continue to face internet access challenges for their most rural residents.

“Connecting people to the health and care services they need is the true promise of broadband,” said FCC Chairwoman Mignon Clyburn during a visit to Mississippi, where she praised the state’s efforts to increase access to mobile health for diabetes patients.

Telehealth does not always reach the patients who seem most likely to benefit from it, either.  A 2013 study found that more urban wealthy than rural poor are engaging in remote consults, while socioeconomic disparities that limit smartphone adoption are leaving other patients out of the loop.  A Pew Internet poll from 2013 found that 44% of Americans still lacked access to smartphones.  Many of those patients were elderly, low-income, or had lower levels of education, and may be more likely to lack regular access to healthcare.

Limited reimbursement opportunities for providers

Even though a majority of patients are eager to embrace telehealth, 41% of providers say that they don’t get adequately reimbursed for the time and effort they spend to provide remote care.  More and more states are passing parity laws that require payers to reimburse for telehealth at the same rate as in-person consults for comparable services, but telehealth advocates believe there is much more work to be done, especially at CMS.

“The number of Medicare beneficiaries accessing telehealth is miniscule.  According to CMS data analyzed by the Center for Telehealth and eHealth Law, in 2011, CMS spent less than $5 million on telehealth services for seniors,” said Krista Drobac, Executive Director of the Alliance for Connected Care and Partner at Sirona Strategies in an article in the American Journal of Managed Care. “This is out of an overall budget of more than $500 billion.”

The American Hospital Association recently asked Congress to expand Medicare coverage for telehealth services in an effort to reach more urban patients and improve the ability of all seniors to access remote care.

“Despite recent expansions in covered services, Medicare is behind the private sector and many state Medicaid programs in promoting telehealth,” wrote AHA Executive Vice President Rick Pollack.  “Given the growing body of evidence that telehealth increases quality, improves patient satisfaction and reduces costs, we believe a more global approach to expanding Medicare coverage of telehealth is warranted.” 

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