Editor’s note: This article is part of a series of blog posts by leaders in health and health care who participated in Spotlight Health from June 25-28, the opening segment of the Aspen Ideas Festival. This year’s theme was Smart Solutions to the World’s Toughest Challenges. Stayed tuned for more.
When my father set up his medical practice in 1935, his arsenal of tools included a stethoscope, a black bag, and an old black DeSoto automobile. While Dad saw patients in the office, he also understood that the best care is care that patients have access to when they need it. He made house calls because he was committed to offering the best care for his patients.
Today’s physicians have a host of new tools to choose from: you can carry an ECG around in your pocket, and scan radiology images on your phone. But the driving principle of care has not changed: the best care is care that patients have access to when and where they need it. Just like Dad’s old DeSoto, telemedicine is an essential tool to deliver care.
Telemedicine Increases Access To Care
According to a recent global survey by Cisco, 74 percent of patients prioritize access to health care services over in-person interactions with health care providers, and 70 percent said they were comfortable communicating with providers via text, email, or video, in lieu of an in-office visit. Furthermore, nearly 60 percent of doctors are willing to conduct a video visit with their patients, according to a nationwide survey of more than 2,000 primary care physicians released by American Well.
This new willingness to embrace telehealth or telemedicine tools provides a much-needed solution to the access, cost, and quality problems in American health care today. The Affordable Care Act (ACA) sought to close the uninsured gap, but coverage does not guarantee access to cost-effective care. In fact, we are seeing an increase in the “underinsured” population as premiums and deductibles rise thanks to increasing health care costs, the ACA’s forthcoming “Cadillac tax,” minimum coverage levels, and mandates against denying pre-existing conditions.
Telemedicine is a critical part of the solution to these challenges. Scientific studies have shown the same desired clinical outcomes for treatment via phone or video versus in-person treatment. Telemedicine provides 24-hour access to a health care provider from any location (as long as it is permitted under state law), and visits typically cost a flat, low rate, as little as $40. As we shift our health system from a fee-for-service model to one centered on value-based care, telemedicine is improving outcomes for chronic care patients.
State Policy Changes Needed To Increase Telehealth Access
Changes, however, need to be made at the federal and state levels to make telehealth access a reality for all those who might want or need it. First, we must fix outdated licensure and practice rules for health professionals. Traditionally, health care providers are licensed on a state-by-state basis, meaning a physician licensed in my home state of Tennessee cannot practice in neighboring Arkansas. But as telehealth can safely cross borders, requiring duplicate licensure and maintaining separate practice rules in each state will only deny underserved populations access to care, leading to worse long-term health outcomes and decreased worker productivity.
In Arkansas, for example, there are 57 counties that have been designated Health Professional Shortage Areas, all of which are in need of additional primary care physicians. These underserved regions could be reached via phone or video by providers in states with higher physician-to-patient ratios, but current state law prevents that from occurring unless the doctor is licensed in both states. Maryland, New York, Virginia, and D.C. are the only states that currently allow licensure reciprocity from bordering states, and just a handful of other states extend a conditional or telemedicine license to out-of-state physicians.
A second challenge facing telemedicine expansion is the failure to provide reimbursement parity. Only twenty-two states and D.C. require state-regulated health plans reimburse for telemedicine services with rates on par with face-to-face consultations, meaning more than half of states do not have laws requiring parity.
Federal Changes To Telehealth Reimbursement Needed
Although Medicare and Medicaid have begun incorporating telehealth technologies, changes to how the programs pay for these services are still needed. Medicare Advantage plans and several Medicare Accountable Care Organizations (ACOs) use telehealth services. There have been several bills introduced in this Congress that would further increase the use of telemedicine, such as allowing Medicare payments for remote patient monitoring in the home (H.R. 3306), providing Medicare coverage for round-the-clock emergency support via telehealth tools (S. 1549), and expanding the use of telemedicine in the TRICARE veterans’ program (H.R. 2725). Additionally, a Senate Finance Committee working group is considering authorizing telehealth for remote monitoring of chronically ill Medicare patients as a part of legislation on chronic care policy changes in Medicare.
But the traditional Medicare program has tightly limited telemedicine payments to certain rural areas. Even in those instances, the beneficiary must already be at a clinic, making care no more convenient. Less than 1 percent of Medicare beneficiaries take advantage of telehealth technologies, despite the potential for long-term savings and improved high-quality access. In fact, a recent Towers Watson study estimated telehealth could save employers $6 billion a year.
Congress is moving toward modernizing our entitlements to employ 21st century tools to meet the needs of today’s patient-consumer. These are federal policy changes the health care community should get behind. Furthermore, we must support state efforts to reform health care laws to accommodate advancements in telehealth technology. 71 percent of employers with more than 1,000 employees are estimated to offer telehealth services by 2017, but employees and their families can only reap the benefits if their state allows it.
With a growing physician shortage, rising health care costs, and a need for increased, measurable quality, we have a responsibility to make changes in how we conceptualize and deliver care. I believe so strongly in this responsibility that I’ve joined the Board of Teladoc, a national telemedicine firm.
The patient-consumer wants to access primary care on their terms, not those of the health care industry. Telemedicine offers this opportunity with maximal convenience to the consumer, with equal quality, and a much reduced cost. Telemedicine is a tool that will transform health delivery for the better.