Telemedicine could mean radiologists in different countries analyzing digital images of your x-rays, patient-doctor video chats, or even live presentations online by physicians or nutritionists to a wide variety of geographically disparate patients.
Seems utopic. So why aren’t we seeing widespread adoption? The technology is available and becoming increasingly cheaper, and both healthcare providers and their patients are becoming more tech-savvy by the day.
Well, it has a little something to do with payments or ‘reimbursement’ in healthcare parlance.
Payment Models
Our current healthcare system functions on a fee-for-service model, where each care session of any sort is monetized. It’s akin to a high school tutor – he or she charges per session, and different subjects may require a different fee. Drawback? It drives costs through the roof.
Healthcare reform seems to be pointing in the direction of ACOs, which would push per-patient payments, providing incentives for wellness and money saving.
But what would a sustainable telemedicine business model look like, one where physicians could be paid for email, video chat, data transfer and other instances where non-physical patient-physician interactions could occur?
Changing Insurance Policies
Monitoring patients at home saves costs through lower readmission, but your practice will lose money unless the examination fee can increase your margin and grab share.
So, if patients and their families pay this cost, the patient receives the costs while the insurer can pocket the savings, which fails to create the mass market these technological advances are looking to foster.
To accommodate telemedicine, insurance companies would need to sell policies with fixed fee-per-patient options so that savings are properly allocated, allowing mass-market adoption.
It’s likely this kind of reform will need to be at least pushed – if not launched – by the US government, with Medicare leading the way before private insurers follow suit.
Membership in ‘capped payment’ health insurance plans is another interesting trend that may help remedy the telemed issue. A 26% increase in managed care plan recipients from 2005 through 2011 indicates these premiums may help spread the use of telemedicine technologies. It ensures physicians are paid adequately and spurs an increase in quality of care.
As of 2011, 12 states have enacted legislation requiring private insurers to cover telemedicine services. However, each state enacts different guidelines, namely regarding what kind of telehealth services insurers will cover. Laws in Maine only cover interactive video sessions and New Hampshire limits telemedicine reimbursement to select pilot waiver programs.
So while private insurers, employers, Medicare, and Medicaid are leading the way, there is still a slant toward payments for a select group of telemedicine technologies. Payment for interactive consultations and telemonitoring of patients with chronic illnesses is limited.
No matter what route a physician takes, we all have to wait for the industry to come around. This could mean joining an ACO, searching for specific insurers with policies to compensate for telemedicine, or practice in states with comprehensive telemedicine compensation legislation. And you can always get creative.
What do you think about payment models for telehealth services? Are insurers and legislators missing the point?
