The downsides of telemedicine include the cost of telecommunication and data management equipment and of technical training for medical personnel who will employ it. Virtual medical treatment also entails potentially decreased human interaction between medical professionals and patients, an increased risk of error when medical services are delivered in the absence of a registered professional, and an increased risk that protected health information may be compromised through electronic storage and transmission. There is also a concern that telemedicine may actually decrease time efficiency due to the difficulties of assessing and treating patients through virtual interactions; for example, it has been estimated that a teledermatology consultation can take up to thirty minutes, whereas fifteen minutes is typical for a traditional consultation. Additionally, potentially poor quality of transmitted records, such as images or patient progress reports, and decreased access to relevant clinical information are quality assurance risks that can compromise the quality and continuity of patient care for the reporting doctor. Other obstacles to the implementation of telemedicine include unclear legal regulation for some telemedical practices and difficulty claiming reimbursement from insurers or government programs in some fields.
In addition to the parity laws, some states require providers to obtain patient consent before using telehealth services. Failure to obtain patient consent may result in physicians not being paid. Providers also have to be aware that while some states do not legally require consent, if they bill telemedicine through Medicaid, they will need written consent.
Although the Patient Protection and Affordable Care Act of 2010 governs telemedicine in certain situations under Medicare, telemedicine regulation for the most part falls to the states. As of spring 2018, 49 states and Washington, D.C., provide reimbursement via Medicaid for some version of live video care, according to the Center for Connected Health Policy, a group that promotes telemedicine.
Remote patient monitoring, which is sometimes called self-monitoring or self-testing, is a means of monitoring patient health and clinical information at a distance. It helps to simplify patient compliance with testing and it lowers the cost of frequent monitoring. It is frequently used in the treatment and management of chronic illnesses like asthma, cardiovascular disease, and diabetes.
A native of rural Washington, Katie Gieseke has practiced medicine since 2009, and provided virtual care since 2015. She received her undergraduate degree in Nursing from the University of Portland and received her Doctorate of Nursing Practice and Family Nurse Practitioner certification from the University of Washington. Her nursing career ranges from experience in the emergency department to home health assessments. During her time in the emergency department, she became interested in improving the effectiveness, efficiency and continuity of the health care system. She has a strong interest in illness prevention and look forward to having the time to spend with patients providing education on maintaining wellness, disease prevention and motivating patients to take control of their health.
“Telemedicine is not a separate medical specialty,” the organization continues. “Products and services related to telemedicine are often part of a larger investment by healthcare institutions in either information technology or the delivery of clinical care. Even in the reimbursement fee structure, there is usually no distinction made between services provided on site and those provided through telemedicine and often no separate coding required for billing of remote services. ATA has historically considered telemedicine and telehealth to be interchangeable terms, encompassing a wide definition of remote healthcare. Patient consultations via video conferencing, transmission of still images, e-health including patient portals, remote monitoring of vital signs, continuing medical education, consumer-focused wireless applications and nursing call centers, among other applications, are all considered part of telemedicine and telehealth.”
State legislation determines the restrictions and often, the reimbursement rates for telemedicine services administered in that state. For instance, any state that has passed a telemedicine parity law has mandated that private payers in that state to reimburse telemedicine visits at the same rate as a comparable in-person visit. While a majority of states have now passed telemedicine parity laws, changing state legislation is often a time-consuming, unwieldy process and can have a huge impact on the telemedicine practices in that state.
Medicaid will cover telemedicine services depending on the legislation passed in that state. Since Medicaid programs are state-run, they follow state-specific telemedicine regulations. In 46 states, Medicaid offers some kind of physician reimbursement for telemedicine services delivered over live video. 26 state Medicaid programs will also pay an additional facility or transmission fee to cover the cost of hosting a telemedicine visit, or transmitting patient medical data in a secure way. The specific restrictions and regulations around telemedicine vary widely by state. To find out more about you’re your state Medicaid program will cover, visit the Center for Connected Health Policy’s recent report.
In the early days, telemedicine was used mostly to connect doctors working with a patient in one location to specialists somewhere else. This was of great benefit to rural or hard to reach populations where specialists aren’t readily available. Throughout the next several decades, the equipment necessary to conduct remote visits remained expensive and complex, so the use of the approach, while growing, was limited.
Telehealth Reimbursement Medicaid: According to Chiron Health, Medicaid systems in 48 states will reimburse for telehealth provided via live video systems while 19 state Medicaid programs will pay for RPM. 12 state programs will finance store and forward telehealth and seven states allow payment for all three telehealth categories. But even though Medicaid is more accommodating of telehealth than Medicare, rules governing payment through state Medicaid programs vary considerably. For instance, some states require patients to be in a medical facility and not at home while receiving telehealth care, and others require a licensed provider to be co-located with patients while they are receiving telehealth services.
Due to its digital nature it is often assumed that telehealth saves the health system money. However, the evidence to support this is varied. When conducting economic evaluations of telehealth services, the individuals evaulating them need to be aware of potential outcomes and extraclinical benefits of the telehealth service. Economic viability relies on the funding model within the country being examined (public vs private), the consumers willingness-to-pay, and the expected remuneration by the clinicians or commercial entities providing the services (examples of research on these topics from teledermoscopy in Australia ).
“It really helped our emergency room with treating stroke patients and benefited patient care by avoiding transportation when minutes matter,” he explained. “We see telemedicine as a solution to expand access to care without leaving the home, as well as a solution for gaining access to a specialist who may not have the patient volumes to relocate to our market.”
While telemedicine has shown to be a game changer in the field of medicine, there are still a number of barriers to overcome. Physicians face challenges regarding how they’ll be paid and where they can practice, while patients voice security concerns. Once these barriers are removed, we can anticipate greater access to care and improved patient outcomes.
Telehealth is sometimes discussed interchangeably with telemedicine. The Health Resources and Services Administration distinguishes telehealth from telemedicine in its scope. According to them, telemedicine only describes remote clinical services; such as diagnosis and monitoring, while telehealth includes preventative, promotive and curative care delivery. This includes the above-mentioned non-clinical applications like administration and provider education which make telehealth the preferred modern terminology.
“It is less about the technology as it is about delivering medicine via a new medium,” Clement explained. “Luckily, the C-suite is accustomed now to teleconferencing, so they have a feel for the benefits, as well as some of the communication struggles that come with being audio-visual from remote locations. Much like teleconferencing, there are situations where telemedicine will fit and others where it will not: It can’t be looked upon as a silver bullet.”
Reimbursement for Medicaid covered services, including those with telemedicine applications, must satisfy federal requirements of efficiency, economy and quality of care. States are encouraged to use the flexibility inherent in federal law to create innovative payment methodologies for services that incorporate telemedicine technology. For example, states may reimburse the physician or other licensed practitioner at the distant site and reimburse a facility fee to the originating site. States can also reimburse any additional costs such as technical support, transmission charges, and equipment. These add-on costs can be incorporated into the fee-for-service rates or separately reimbursed as an administrative cost by the state. If they are separately billed and reimbursed, the costs must be linked to a covered Medicaid service.
“Another distinction between telemedicine and D2C telehealth is that telemedicine consultations are often with medical specialists like cardiologists, dermatologists and pulmonologists,” Downey continued. “These often occur when the patient is in an underserved rural community and the specialist is in a large urban area. The distance makes it difficult to make and keep appointments otherwise. D2C telehealth, on the other hand, best deals with minor primary care issues over the phone. If deemed to be a more serious health concern, the patient is told to make an appointment with a specialist or to proceed to a hospital emergency room.”
4. Your pharmacist will then tell you what medication you can have and how much you will have to pay for it. Based on your doctor’s recommendation, costs, and other personal factors, you can now decide what medication to use. It’s a good idea to consult with your doctor to determine what medication would be most effective for your health while staying within your budget.