2018 may well go down as the year of telemedicine expansion.
Telemedicine, or healthcare facilitated by means of video, phone, or other telecommunications technology, has been around for decades.
Yet last year, major players across the healthcare industry made significant investments in it. Pharmacy giant CVS introduced virtual care offerings to its MinuteClinics. The Cleveland Clinic announced that telemedicine would be a major component of future care across the health system. And telemedicine vendor TelaDoc announced a new global initiative supporting remote care in more than 20 languages. And those are only a few of the telemedicine-related plans announced over the past 12 months.
These initiatives beg an important question: As corporate telemedicine offerings continue to expand, what will be the impact on physicians outside of major health systems?
“There is currently pressure on physicians to consider alternate shared services delivery models that telemedicine solutions can offer,” says Neha Sachdeva, MS, a director at KPMG’s Healthcare & Life Sciences practice, referencing new ways provider organizations can extend their services using virtual care delivery methods. “But there is no one-size-fits-all strategy for telemedicine use.”
She argues that, with telemedicine platforms ranging from a few thousand to tens of thousands of dollars, physicians need to think beyond the cool factor of recent telemedicine advances and consider how such systems will improve patient health and solve business needs.
Understanding corporate expansion
Telemedicine, despite not being a new technology, remains a buzz word across the healthcare industry. And for good reason: Instead of costly and time-consuming in-person encounters, physicians can rely on video visits, smartphone photos or other means to assess, treat, and manage patients with medical problems.
Ana María López, MD, FACP, president of the American College of Physicians, says that a renewed focus on value-based care has brought telemedicine into the spotlight.
“Telemedicine offers opportunities for significant savings. There is a strong case to be made for its use to expand patient access to care and to reduce medical costs,” she says. “So it’s not surprising that we are seeing more solutions out there.”
Take video conferencing in an ambulance, she says. EMTs can send information, including images or other important clinical data to the trauma team waiting at the emergency department. That can result in streamlining care and significant savings in time and treatment costs.
Sachdeva agrees. “There are a lot of pressures, certainly, to adopt this kind of solution,” she says. “But there are also internal drivers—to reduce wait times to see a particular provider, to offer patients, who are looking for more consumer-centric healthcare, more options about how to receive care, and to help streamline workflows for the providers themselves.”
William Morris, MD, MBA, Cleveland Clinic’s associate chief information officer, says its foray into telemedicine is due to a combination of all of those factors. “First, it’s the right thing for patients, when appropriate, to see them where they are and create a high-touch experience at their convenience,” he says. “But telemedicine also offers a lot of operational efficiency.”
Morris argues that when physicians can answer questions and review tests remotely, it is more efficient for the provider, the practice, and the patient. “We’re trying to change the way we think about practice—because there’s not just one way to provide care. You should be able to get our clinical expertise without having to deal with our parking,” he says.
Daniel Barchi, MS, chief information officer at New York-Presbyterian Hospital, believes that telemedicine is poised to fundamentally change the way medical care is provided—in practices of all shapes and sizes. New York-Presbyterian currently uses telemedicine for emergency department triage as well as for peer-to-peer physician communication—and Barchi says the hospital plans to expand its offerings.
“If we are not investing in this area and providing great care and service to our patients through it, we are not going to be prepared for the way medicine is delivered in the future,” he says.
Factors to consider
But despite these motivations, as well as multiple studies suggesting that telemedicine provide outcomes equivalent to traditional in-person visits, some physicians remain skeptical about how the technology can benefit their practices.
A recent Healthcare Information and Management Systems Society analytics survey reveals that 55 percent of hospital respondents were not sure they would invest in telemedicine in the next two years. A 2017 Medical Economics survey looking at telemedicine adoption in smaller practices found that less than 20 percent offered such services.
In both studies, providers acknowledged the value of implementing such platforms to promote efficiency. But they said the return on investment was not clear. Between the price tags on current telemedicine platforms and the unknowns regarding costs of liability insurance and payer reimbursements, many providers feel, at this point, the investment is too risky.
Contrast those findings with a 2018 survey by Software Advice, a consultancy that helps organizations select the right software, including telemedicine options, showing that 77 percent of consumers would be more likely to select medical providers that offer telemedicine services—and that the majority of patients who use telemedicine appreciate its convenience.
The findings suggest physicians may be underestimating consumer interest in telemedicine options—both now and in the future.
Sachdeva says that as no two physician practices are the same, no telemedicine strategies should be either. Before considering adoption, physicians should determine where, when, and how a particular option can benefit the practice and its patients. She suggests providers look at their current patient base and see in which situations telemedicine may be appropriate.
Developing inclusion and exclusion criteria by looking at specific cases—perhaps a remote visit for a regular check-in with a diabetic patient, but an in-person appointment for the same patient if he is complaining of neuropathy-like symptoms–lets practices better determine whether a remote care delivery model is right for them.
Providers may benefit from building or leveraging relationships with other organizations to make the most of telemedicine platforms. For smaller practices, aligning with a hospital or partnering with other practices may help alleviate some of the cost burden. Such relationships can also provide guidance about how to best deploy telemedicine programs.
Sachdeva says creating successful remote offerings won’t be as simple as following in the exact footsteps of bigger organizations but smaller providers can learn what to do, and perhaps more importantly, what not to do. It’s important for finding the right telemedicine vendor, she says—one who can work with the practice to set up a system that meets its specific needs.
“It really all goes back to, ‘Why am I doing this? What case studies makes the most sense here? Who am I trying to target? How will it help improve care and lower costs?’” says Sachdeva.
Providers who take the time upfront to answer those questions—and look closely at the factors that are driving them to consider telemedicine—will be at an advantage. They can then look to other healthcare organizations with similar drivers, or vendor partners who specialize in those areas, to help them find the way forward.
But it’s important, Barchi adds, that such analyses should be physician-led. “Where we’ve been most successful is letting our physicians tell us what issues they are facing and how telemedicine might help them better manage those issues—whether it’s reducing wait times in the emergency room or having an expert assist you on a complex surgery from 1,500 miles away,” says Barchi.
What can physicians outside large health systems do to counter corporate telemedicine expansion? To start: their homework. That means investigating where, when, and how remote care delivery models can help them treat patients, and the specific business cases practices hope to address through their use, Sachdeva says.
But it continues with knowing how telemedicine will link up with electronic health record (EHR) systems.
“Think about what kind of telemedicine solution you might use and what kind of documentation needs to be [in the EHR] to support the care delivery you’re providing—and your reimbursements,” she says.
Sachdeva adds that physicians need to consider medical liability when adding telemedicine services. A practice’s malpractice insurance plan may need to change to cover remote care delivery. While many physicians may assume telemedicine will raise liability, that is not always the case. Doctors should discuss their options with their insurance provider, including what type of coverage makes the most sense for the platform they are implementing.
Product liability is a concern: if the technology isn’t reliable, care can and will suffer. And practices need to review their insurance contracts, Sachdeva says. Telemedicine reimbursements can vary greatly from payer to payer—and providers may have to renegotiate some terms if they take on a telemedicine care model. “There are lots of pieces and parts to think about before deploying a system,” Sachdeva says.
Morris agrees. “I think any successful telemedicine program starts with a physician evangelist who uses facts and data to bring others along. Telemedicine isn’t something that can be done to physicians. It needs to be done with physicians,” he says.
He adds that practices need to carefully consider payment parity, or how much a physician is paid for services rendered in person versus remotely, when discussing any telemedicine deployment.
“You need to align incentives—for the patient and the physician,” he says. “But you also need to think about reimbursement. It’s important that any telemedicine solution reflects the work of the physician.”
He maintains that just because doctors are seeing patients virtually does not mean less work is involved than an in-person visit. “These visits still take time and are still leveraging a physician’s intellectual capital in terms of practice and expertise,” he notes.
Telemedicine’s impact on medical practices
Telemedicine holds a lot of promise to help medical practices promote efficiency, reduce costs, and increase patient satisfaction. But Lopez cautions that it is just another tool in a clinician’s care delivery toolbox, not a healthcare panacea.
“As with any tool used to care for patients, it’s important to use it appropriately,” she says. “It’s important for physicians to take a long view, assess where it can appropriately answer the diagnostic questions at hand, and make sure they are doing the right clinical thing for each and every patient.”
Morris says that telemedicine scales well—from large health systems like Cleveland Clinic to smaller rural practices. By taking the time to plan, looking at everything from the financials to changes in practice workflows, even smaller practices can reap the benefits.
But consumer expectations will drive even the smallest providers to find ways to affiliate with organizations who can help them implement at least some telemedicine options. With the technology continuing to expand across the globe, patients will increasingly expect access via telemedicine.
“Instead of calling a pager or service, the patient is going to expect a quick video visit. I think we’ll see adoption being less physician-driven and more consumer-driven as time goes on,” he says.
Morris cautions that no two practices are the same—and there are a multitude of experiences that telemedicine may augment at the provider level.
”Telemedicine can help with many different cases in a way that benefit the patient, the provider, and the financial systems without the burden of overhead involved with an in-person visit,” says Morris. “It’s a time where we can really reimagine the way we want to experience healthcare, as patients and as providers.”