This section covers four areas.  It explores the application of Telehealth to your practice.  The first area covers the need for telehealth and its rapid expansion.  The projections are for a 19% year over year increase in the next 6 years resulting in a $ 66 Billion annual market.  The second item explores how that affects you, as a provider (It will have an effect, one way or the other).  The third item is payment for telehealth services.  If you can’t get paid, it is hard to support.  The last item is timing.  Even though Telehealth has progressed a great deal over the last couple of years, it is still in its infancy.  Is it better to act now or to wait?

The Rise of Telehealth is Unstoppable.  Over the past few years, study after study has shown telehealth to be very popular and effective.  Most of these studies originate from large hospital groups and state public organizations.  The results of most have been very positive.  I’ve seen projections that show the industry growing from less than a million consults annually (currently) to 158 million in 5 years.  This is called the “consumerization of America”.  It is no different from online shopping or online banking.  It takes a while to get started, but there is no stopping it.  Convenience rules, but it also leads to better outcomes.

Speaking of outcomes, telehealth really shines in an emergency.  Most people are never very far from a computer or smartphone.  With an available telehealth system, I can video with my doctor in minutes.  It is very efficient and comforting to know my doctor is so close.

 

Telehealth is unstoppable

Convenience is King

Just like shopping and banking

 

Great for Emergencies

 

I could go over study after study, but instead I will just refer you to a couple of good articles.  The first is an advertisement by Avaya. Avaya could be considered a competitor, but we really don’t compete.

Improving Patient Care and Experience—5 trends to watch in 2017

The second is an article titled “Why CIOs must work with marketing execs as consumerism takes hold”.  It is an article by Nick Vennaro published in Health Data Management.  It explains why the current B2B fee-for-service model will be replaced by a B2C value-based care model.

(Health Data Management Link)

Most, but not all, studies have shown positive results.  One important study showing negative results was done by the CBO (Congressional Budget Office).  It showed that telehealth actually increased the cost of care.  It has led to a major stifling of telehealth by Medicare and Medicaid—two very important players.  Let’s look at this more closely.  First, the study was done in 2001 when the cost of telehealth was much more expensive than today.  Second, the convenience factor led people to use it more, which made it more expensive.  The CBO says this is a bad thing; but is getting care when you need it, bad or good.  It may be bad for short term finances, but it is good for long term healthcare outcomes.  Recently, the CBO has changed their position, and now favors telehealth.  This will encourage Medicare/Medicaid to promote it rather than stifle it, but change is slow.  Hold the press (I’m adding this after the original post).  Today, a news release says, Senate unanimously passes bill expanding Medicare telehealth services.  Maybe it is coming faster than I expected.

 

Medicare and Medicaid have been slow adopters,but they are gradually coming around.

I predict a big push soon

Soon just happened

Senate just passed Chronic Care Act promoting Telehealth

 

How will Telehealth affect Me?   How it affects you depends on you.  Practices will find it harder and harder to maintain their patient population if they don’t offer a telehealth option.  So the question is “At what cost?”  I promote and recommend ConnectUsMed.  The cost for a small practice consisting of a doctor, nurse, and receptionist is only $ 100 per month.  The cost is easily offset by the benefits.  This is a small price to pay to maintain and grow your practice.  More about this is coming later.

Telehealth providers can be segmented into a few types.  The first is a company that specializes in telehealth.  This segment includes Teledoc, American Well, Doctor on Demand, MD Live, and more.  They advertise for patients seeking a convenient and fast experience.  They often charge a flat fee for a consult and don’t even worry about insurance.  Another segment is a large health organization like UPMC (University of Pittsburgh) or Boston Children’s Hospital.  They provide experts and specialist to patients living in rural areas in states they serve.  This group also works with patients needing acute care or post-operative care.  Psychiatry, behavioral and nutrition care is another popular segment.  Many think remote consults actually are better than onsite visits in these specialties.  Another area is education of both the doctor and the patient.  Finally, using virtual visits to acquire second opinions is popular.

Telehealth will permeate all areas of medicine just as online has permeated shopping, banking and many other areas.  Now people buy cars, homes, clothes, etc. online.  They will do the same with healthcare.  I only live a couple miles from my doctor, but many times I wish my appointment could be virtual.  I am very time conscious and going to the doctor is not something I want to waste time on.  I don’t think I am alone.

 

 Telehealth will permeate all areas of medicine.

Convenience is just too compelling

Getting paid—Of course if you’re going to provide virtual consults, you want to get paid.  Like many things in medicine, getting paid is tricky.  All states are a little different and all insurance providers handle it a little differently as well.  Getting paid used to be very difficult, but every year it gets a little easier.  For private insurance, there are now 32 states that have parity laws, meaning virtual consults have the same status as onsite consults.  Nine others have partial parity and only nine have no parity.  Every year brings new changes and most make telehealth easier.  For more detail on state specific information check the website of the Center for Connected Health Policy at this address.  http://www.cchpca.org/telehealth-medicaid-state-policy  The American Telemedicine Association is also a good resource.

Another determinant to getting paid is the type of telehealth services provided.  Two-way real-time video is the easiest way to qualify.  This is the type ConnectUsMed uses and recommends.  Other methods are more difficult; for instance email or audio only.

 

We all want to get paid

Insurance payment is getting easier

  • 32 states have parity laws
  • 9 have partial parity
  • 9, nothing

Video, (ConnectUsMed uses) is the easiest way to qualify for payment

Some bypass insurance as patients are willing to pay for convenience

 

Medicare rules seem particularly difficult and backwards.  They do allow for payment, but have many rules.  The patient must live in a HPSA (Health Professional Shortage Area).  This generally equates to a rural area.  Also, the consult must originate from one of several categories.  These include hospitals, doctor’s offices, rural health clinics, skilled nursing facilities, etc.  It seems to me, if I am sick, I would like to be at home.  It doesn’t cover that at all.  I have to go somewhere and then telehealth into the doctor.  Medicare does pay for both ends of the call, but that seems strange to me as well.  It makes for an expensive encounter.  I think it is designed for 10 years ago when you needed special equipment and networks in order to connect.  Today things have changed.  I would say that any place that has cable television (most places) would also have an adequate network connection.

I mentioned earlier, that for a long time the CBO thought telehealth would drive up healthcare costs, but recently changed their position and now recommends it.  I think this will go a long way in changing the Medicare rules.  Change takes time, but it will happen.  I read recently that the American Heart Association was pressuring Medicare to loosen the rules as well.  I predict they will soon do a complete 180 and start to push it.  There is just too much evidence for them to ignore.

The push for telehealth will only get stronger.  As value-based care becomes the norm, as habits change, and consumerism takes root, the drumbeat will only get louder.  All stakeholders want better and cheaper care and telehealth is a good opportunity to do just that.

Telehealth is now recommended by the CBO

Medicare will surely follow

 

Telehealth offers the opportunity for better and cheaper care while providing for more convenience.

 

Sooner or Later—Telehealth is coming, but is it here?  Should I act now or should I wait?  You really need to evaluate the costs and benefits of doing it now.  I recommend doing it now.  Let me show the arguments.  The cost of ConnectUsMed is very modest.  A small doctor’s office is only $ 100 per month.  You will get immediate value out of the automated patient history and referral functions to pay this $100.  That means the telehealth function comes free so even if it is sparsely used, it hasn’t been a cost burden.

There is another factor that is more important than the money.  Change and habit take a long time to break and change.  This is true for your staff and even more importantly for your patients.  If you were to adopt ConnectUsMed today, don’t expect an overnight change.  It will take years for the real transition to occur.  It will be a gradual process.

ConnectUsMed is designed to educate the patient over time and make them aware of the possibilities without beating them over the head.   Then, someday when they see an advertisement from a Telehealth specialty company and they have a need, they will call you rather than getting involved with a competitor.  Once they try it, they will be hooked and want to do it again.  It is a gradual process to implement a successful program.  ConnectUsMed introduces it very slowly by encouraging related activities like our patient history and referral process.  ConnectUsMed uses a patient flow that both patient and staff will be comfortable using.  They will forget the appointment is virtual.

 

Telehealth–Now or Later

ConnectUsMed provides value from day one

It educates you staff and patients for the ultimate goal–virtual office visits.

The change will come gradually, but it will come. Be prepared.

 

The bottom line is ConnectUsMed will drive traffic by educating the staff and patient to want to try it.  Once they do they will see how similar to a normal office visit it is, but vastly more convenient.  This will drive adoption and help to retain and even increase your patient population.  The benefits far out way the modest cost.

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