By Matt Fisher, Esq
Twitter: @matt_r_fisher
Host of Healthcare de Jure – #HCdeJure
The technology behind and supporting telemedicine has come a long way in a short period of time. To some degree, the development reflects general technology. It can be hard to remember given the ubiquity of smartphones and other mobile devices that communication and video anywhere and everywhere is still relatively new. Going back less than ten years, it was not possible to talk by audio or video anywhere. Instead, video streaming was relatively difficult and did not provide great quality. Now, a smartphone provides HD quality video almost anywhere. The explosion in access has driven such services, which can fuel the use of telemedicine.
Given the theoretical ease of access to video and audio communication, what does that mean for telemedicine? It means that telemedicine is posed to break through barriers impacting access to care at least from the technological side. From a non-IT perspective, there do not appear to be many technology based barriers to accessing and utilizing telemedicine. Easy and readily available videoconferencing exists in platforms that everyone can access. As indicated, videoconferencing, typically in the form of FaceTime, can be used by almost anyone at any time. Why has healthcare apparently not caught on?
One popular narrative to the inability to widely access telemedicine is that healthcare is slow to adopt new technology. However, that adage is applied to many professions, including mine of law. It is an easy thing to say that does not necessarily reflect reality. Technology pervades all aspects of life and it is increasingly coming into all professions. If there is a benefit to providers and patients, I expect that more often than not the tool will be utilized. Adoption will be true whether it is a new medical device, pharmaceutical, or other solution. Change occurs and no industry is immune.
However, change may need to be accompanied by incentives. For example, healthcare as is widely known went through a massive adoption spree for electronic medical records. Usage and adoption was not widespread, until the federal government passed and implemented the Meaningful Use program. With that program in place and providing financial incentives, healthcare providers and hospitals ramped up implementation very quickly. The availability of federal dollars also resulted in a proliferation of vendors. However, such financial incentives also provide a cautionary tale. For electronic medical records, adoption occurred very quickly as a result of the availability of incentive money. The resulting systems did not necessarily meet the needs and expectations of healthcare providers, which has caused continued frustration and complaints.
In this climate, telemedicine is now trying to become the latest technological development to garner the attention and support of healthcare. Like electronic medical records, a financial incentive is needed. For telemedicine though, the financial incentive will not constrain and artificially accelerated adoption. Instead, the financial incentive should be in the form of reimbursement for services and care provided. Telemedicine is not necessarily a technological innovation so much as a technologically enabled extension of care delivery. Telemedicine brings healthcare services to remote areas and increases the ability to obtain certain type of care, whether primary or specialty. However, these services cannot be provided for free. Reimbursement on a consistent basis is necessary. Increasing integration into healthcare, whether as a health insurance benefit or retail availability, accustoms all involved to providing payment. As money continues to flow in, use will continue to increase as well.
Related to reimbursement is the potential for telemedicine to fit into value-based care initiatives too. Even if a telemedicine service is not specifically reimbursed, if it can be utilized to reduce unnecessary patient visits or help a patient improve from home, then it provides value. With healthcare shifting away from fee-for-service, resources that create outreach and easy touchpoints with patients will be extremely valuable.
Demand for telemedicine can also play a role in another current barrier to telemedicine usage: laws and regulations. Right now, each state has its own rules, whether imposed by a local board of registration in medicine or from actual legislation. The Centers for Medicare and Medicaid Services also follow different rules as to when telemedicine may be allowed. The differences between all of these laws and regulations requires a significant amount of attention to ensure that services are provided in a legal manner. Complying with all of these requirements also imposes significant costs on the providers, which in turn impacts how cost-effective or cost-conscious the services can be.
Despite these barriers, hope is appearing on the horizon. Telemedicine providers and consumers are seeking more consistent access and responses are occurring. States with very restrictive rules are fiancé challenges, with Texas as a prime example. Not only are restrictive rules being challenged, but the federal government is siding against the state government. Such a balance puts other states on notice that restrictions will not be tolerated.
What do all of these actions mean for access to and use of telemedicine? Telemedicine access should begin to reflect non-healthcare access to remote communications. Healthcare cannot remain an exception to access when and where wanted. Too much is at stake for all sides to resist this level of change. Optimistically, these pressures are beneficial. Widespread access is to telemedicine adds another tool to the chest for healthcare and can help result in better care. As stated at the beginning, there is a tremendous amount of promise associated with technology, including telemedicine. That potential still needs to be harnessed, but the day for telemedicine is coming closer and closer.
National Health IT Week is an ideal time to continue this push. Telemedicine takes advantage of so many IT developments and should be celebrated. Many innovators, whether start ups or established companies, are pushing boundaries and seeking new ways to deliver care. Let’s celebrate these achievements, but also say keep going and keep finding new solutions.
About the author: Matthew Fisher is the chair of the Health Law Group at Mirick, O’Connell, DeMallie & Lougee, LLP, in Worcester, MA. Matt advises his clients in all aspects of healthcare regulatory compliance, including HIPAA, the Stark Law and the Anti-Kickback Statute. This article was originally published on Mirick O’Connell’s Health Law Blog and is republished here with permission.