Long regarded a “nice-to-have” in the industry, telemedicine emerged during the pandemic as a necessity with multiple challenges across the revenue cycle continuum for patients, providers and payers. Today, it’s being touted for its potential to provide superior care at a lower cost than traditional methods, and with good reason.
- A 2018 study published by the American Journal of Emergency Medicine found that net cost savings per telemedicine visit can range from $19-121 per visit.
- Telemedicine has great potential for patients working to manage chronic conditions as physicians can better monitor lifestyle issues and deal with issues proactively, increase access to specialized care and reduce readmissions.
- Physician-to-physician telemedicine can give patients better access to expertise across the state, country or world.
In order to reap the benefits of a robust telemedicine strategy, however, stakeholders across the industry must face certain key challenges and take steps to overcome them before forging ahead.
4 Key Challenges to Overcome
Below are four areas healthcare organizations should address as a first step to building a lasting telemedicine program.
1. Rural access
At the onset of the pandemic large health system practices already had significant technological infrastructure in place, but many rural hospitals struggled to keep up. In addition, patients with connectivity issues had an obvious barrier to video visits. Prior to the pandemic, CMS reimbursed audio-only visits at one-third the rate of audio-video visits. In April 2020, CMS aligned payment for the two but is likely to revisit its policies in the future. If rural health systems can’t improve their position when it comes to access, the disparities that exist between urban and rural areas today will only become worse.
Given the existing financial challenges faced by rural hospitals, they’ll most likely need support from larger health systems or communities that already have the necessary infrastructure in place. Leaders of rural hospitals should look at creating formal alliances or other partnerships to help reach patients. This move will take innovation but could strengthen the organization’s position in the community. For example, hubs could be created in schools, firehouses, clinics, etc. to provide broadband coverage for patients to improve access to care.
2. Inconsistent payer practices
Although both commercial and government payers have relaxed some practices, guidelines remain inconsistent, creating confusion among providers and slowing down payment. While patient-driven demand is mostly limited to rural areas, patients in metropolitan areas are increasingly seeking remote services as well. Physician practices and other stakeholders will need to continue to demonstrate telehealth’s value to ensure its viability on a go forward basis in order to change payer behavior for the better.
3. Physician adoption
Providers have not taken a uniform adoption to telehealth, creating confusion among patients and giving payers no sense of urgency to permanently relax rules around virtual visits. Leaders who wish to bolster their telemedicine strategies can obtain buy-in from physicians by emphasizing the potential clinical and population health benefits. Telemedicine allows for more consistent access to care for a greater population, even when treatment occurs over the phone. The ability to reach more patients and provide better continuity of care is in itself an incentive for physician buy-in.
That said, it may truly require an additional legislative push for continued reimbursement enhancement in order to find the necessary equipment and push more providers into a more formal telemedicine career. Telemedicine as a specialty is the wave of the future, and reimbursement needs to catch up.
4. The slow march to value
Telehealth is traditionally reimbursed on a fee-for-service basis but could become more rapidly adopted with provider incentivization and risk sharing. Value-based care models and practices that have adjusted clinical workflows to accommodate telehealth would likely have an easier transition, while smaller practices or those serving disadvantaged groups may not have the capacity or financial stability to incorporate telehealth effectively.
Those practices that have struggled would be well advised to take the following actions:
- Set clear defined priorities determining how telemedicine will be used in the practice
- Become familiar with state and reimbursement guidelines
- Research the various telemedicine technology platforms available, choosing one that supports practice priorities and meets both regulatory guidelines and that of your community/ patient population
- Involve all stakeholders in the decision-making process, including office staff
- Enlist the assistance and feedback of their revenue cycle department or partner
|By Bryana McGill,
Vice President Revenue Cycle
Ensemble Health Partners
These materials are for general informational purposes only. These materials do not, and are not intended to, constitute legal or compliance advice, and you should not act or refrain from acting based on any information provided in these materials. Please consult with your own legal counsel or compliance professional regards specific legal or compliance questions you have.