Telehealth essential guide for doctors, nurse practitioners, office managers, and practice administrators. We cover everything you need to know about telehealth.
Table of Contents
What Is Telehealth?
Telehealth uses digital technology to deliver medical services and health education by connecting multiple users in different locations. It allows health care professionals to do evaluation, diagnosis, treatment, assessment, monitoring, communication and education of patients at a distance using technology.
Telehealth includes a wide range of information, networking and digital imaging technologies, delivered primarily in three ways: video conferencing, which provides real-time patient-provider consultations and provider-to-provider discussions; remote patient monitoring, in which electronic devices transmit patient health information to healthcare providers; and store-and-forward technologies, which transmit digital images, such as X-rays, computerized tomography (CT) scans and video clips between primary care providers and medical specialists.
History of Telehealth
What we recognize as telehealth today started in the 1950’s when a few hospital systems and university medical centers started to try to find ways to share information and images via telephone. In one of the first successes, two health centers in Pennsylvania were able to transmit radiologic images over the phone.
In the early days, telehealth 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.
The rise of the internet age brought profound changes for the practice of telehealth. The proliferation of smart devices, capable of high-quality video transmission, opened up the possibility of delivering remote healthcare to patients in their homes, workplaces or assisted living facilities as an alternative to in-person visits for both primary and specialty care.
Telehealth vs. Telemedicine
Although the terms telehealth and telemedicine are often used interchangeably, there is a distinction between the two. The term telehealth includes a broad range of technologies and services to provide patient care and improve the healthcare delivery system as a whole.
Telehealth is different from telemedicine because it refers to a broader scope of remote healthcare services than telemedicine. While telemedicine refers specifically to remote clinical services, telehealth can refer to remote non-clinical services, such as provider training, administrative meetings, and continuing medical education, in addition to clinical services. According to the World Health Organization, telehealth includes, “Surveillance, health promotion and public health functions.”
Telemedicine involves the use of electronic communications and software to provide clinical services to patients without an in-person visit. Telemedicine technology is frequently used for follow-up visits, management of chronic conditions, medication management, specialist consultation and a host of other clinical services that can be provided remotely via secure video and audio connections.
Using telehealth as an alternative to in-person visits has a host of benefits for patients and providers alike.
• Less time away from work
• No travel expenses or time
• Less interference with child or elder care responsibilities
• No exposure to other potential contagious patients
• Increased revenue
• Improved office efficiency
• Answer to the competitive threat of retail health clinics & on-line only providers
• Better patient follow through and improved health outcomes
• Fewer missed appointments and cancellations
• Private payer reimbursement
Healthcare Services Provided via Telehealth
A wide variety of clinical services are provided using telehealth technologies.
Primary and Follow Up Care
In many cases, a remote visit using high definition video and audio conferencing can replace an in-person
visit to the doctor’s office. The patient and provider connect using an application designed for the purpose. The patient may participate using a personal computer or smart mobile device. In this case, the patient can be anywhere that offers sufficient privacy.
Both stand-alone urgent care clinics and primary physician’s offices are leveraging telemedicine to provide urgent care services. Many urgent, but non-life threatening conditions can effectively be diagnosed and treated remotely, keeping patients out of crowded emergency rooms and clinics.
Certain conditions, such as preeclampsia, hypertension, heart disease and diabetes, can best be managed with real-time information about patient vital signs and activities. Telehealth technology can be used to transmit and store this type of data.
Psychiatric Services and Counseling
Telehealth is ideally suited for psychiatric services, cognitive behavioral therapy, and lifestyle coaching, including weight management and smoking cessation.
Telehealth can also be used to leverage the expertise of specialists who are not physically present. The patient may be in the office of their primary physician when a video visit is conducted. Alternatively, the primary physician may use a telehealth approach known as store-and-forward to provide relevant information to the specialist for evaluation.
School Based Healthcare
Schools have found that telehealth is an effective way to get students necessary medical attention with minimal interruption to their school day.
Assisted Living Support
Care teams at assisted living centers and skilled nursing facilities can receive the support of remote providers via video, making it possible to get patients the care they need without the complexity of transportation.
Online Only Medical Services
A growing number of companies provide online only access to physicians and nurse practitioners. Patients can simply access a website and receive care for a limited number of conditions on-demand.
How Telehealth Benefits Healthcare Practices
Telehealth is good for providers, patients, and the entire practice. These advantages explain the increasing popularity of the approach.
The Impact of Telehealth
Technology has been changing the
practice of medicine for decades. Digitized medical records, modern practice management systems, online payer portals, and the like all allow physicians to operate more efficiently with fewer opportunities for error. Telehealth is another technology that is poised to make practices more profitable, improve patient outcomes, and give providers unprecedented flexibility. Conducting some visits remotely using telehealth technology has significant upside potential for practices. Here are a few of the benefits.
Video visits are more efficient than in-person ones. This means that each provider can see more patients during the same period of time. When the service is offered to patients with insurers that will reimburse for telehealth, practices can enjoy revenue growth without the need to add providers, office staff, or office space.
Modern telehealth technology can be used virtually anywhere, at any time. This gives practices the option to offer extended hours or even weekend operations without requiring the physical office to be staffed.
Improved Patient Health Outcomes
Patients are more likely to comply with recommendations for follow-up appointments if those recommendations can be conducted via video. Video visits are also an effective way to increase patient engagement in lifestyle coaching, medication monitoring, and the management of chronic conditions. Surveys show that patients feel as satisfied, or even more satisfied with telehealth visits.
Improved Work/Life Balance
Telehealth gives providers the option to work from home part of the time, or to see patients outside of traditional office hours. In fact, many providers find that telehealth technology helps them maintain a healthier work/life balance. For example, it is common for medical providers to report being reluctant to take a vacation or travel on business. Telehealth reduces this anxiety because a video visit can be conducted from anywhere. Providers who use it can travel far from home, confident that they can still provide patient care if needed.
Protection from Competition
Today’s patients have many options besides a traditional physician’s practice for care. Retail walk in clinics and stand-alone urgent care operations are convenient ways for patients to get on-demand in-person care. In addition, the number of organizations offering online video visits continues to grow. These avenues are cost effective and painless for patients. Adding telehealth to a traditional practice is one way to protect against this type of competition.
In addition to the benefits of telehealth for healthcare providers, there are advantages for office staff as well. Video visits make everyone more efficient by removing the administrative overhead of in-person visits. Office staff appreciates less waiting room crowding, and happier customers. Telehealth also reduces their exposure to illness. And, of course, improved practice profitability benefits all employees.
Fewer No-Shows and Last-Minute Cancellations
No-shows and last-minute cancellations are big profit drains and time wasters for medical practices. This frustration can be mitigated with the help of telemedicine by eliminating many of the factors that cause them. Transportation issues, the need to be at work, and lack of access to child care don’t matter for a video visit. Some in-person visits can even be switched to remote ones if something comes up at the last minute that prevents the patient from making it to the office.
Reimbursement for Follow-ups
Another way that telehealth helps revenue growth is by turning something that providers often do for free today into a revenue stream. Most payers do not reimburse for telephone only follow-up visits, like those conducted to review test results or check in on the progress of a case. However, using teleheatlh technology to add a video component often makes them reimbursable.
As this list illustrates, telehealth is good for providers, patients, and the entire practice. These advantages explain the increasing popularity of the approach and why providers, lawmakers, insurers, and customers are all on board.
Learn about the Top 5 Telehealth Myths.
Reimbursement for Telehealth
Today, more and more healthcare practices are implementing telehealth programs. One of the main reasons is that these programs offer the opportunity to increase profitability.
revenue generating encounters, and minimize the problem of no-shows and last-minute cancellations.
Of course, this will only impact the bottom line if you get reimbursed for these telehealth encounters. That’s why it is essential to familiarize yourself with the complex set of laws, policies, and regulations that determine how payment for telemedicine is handled.
Be sure to checkout the Billing for Telehealth Encounters: An intoductory Guide On Fee-For-Service.
Telehealth Reimbursement by Private Payers
The good news is that the popularity of telehealth is driving legislators and insurance executives toward more progressive policies regarding telehealth. However, for now, there is a patchwork of coverage. To learn more about the latest in state telehealth related legislation, visit Center for Connected Health Policy (CCHP) interactive map.
State Parity Laws
Currently, all 50 states & D.C. have laws that require private insurers to reimburse healthcare providers for services delivered through telehealth. These laws generally prohibit private payers from taking into account the patient’s location when making a reimbursement decision. This allows patients to conduct video visits from their home or office.
Eligible Providers and Technologies
All states with parity laws include real-time video conferencing as an acceptable form of telehealth. Some also cover the store-and-forward approach. For the most part, any provider that can bill for an in-person encounter is eligible to be reimbursed for a video visit. But keep in mind that each state’s medical board is tasked with determining which professionals are covered under state parity laws.
States also set the reimbursement amounts. Many require that private payers reimburse the same amount for remote visits that they offer for in-person ones. Some states leave that decision up to the insurer. State laws aside, many private payers realize the efficiency of telehealth and voluntarily reimburse at the same rate as in-person encounters even if the state does not require it.
Many states with parity laws have made exceptions for certain types of insurance plans. Worker’s compensation plans and small group plans may be eligible to opt out of coverage for telehealth.
Medicare & Medicaid Telehealth Reimbursement
Medicare takes two different approaches to telehealth reimbursement. The standard approach covers most patients and is a geographically limited hub-and-spoke model. There is also a new Chronic Care Management program that allows reimbursement for some video-visits.
Geographically Limited Hub-and-Spoke
Telehealth reimbursement under Medicare was targeted toward patients who live in rural or remote areas with limited access to specialists. For this reason, in order to be eligible for reimbursement, patients must live in a Health Professional Shortage Area (HPSA) that is outside of a metropolitan area.
Medicare also requires that patients be present at what’s called an “Originating Site.” Originating sites include places like doctors’ offices, hospitals, skilled nursing facilities, rural health clinics, and community mental health centers. If a patient is not at an approved originating site, video visits are not eligible for reimbursement.
This means that remote visits from the patient’s home are not covered.
Chronic Care Management (CCM) Program
Medicare recently introduced the Chronic Care Management Program. This program compensates providers that coordinate the care of Medicare patients who have two or more chronic conditions. It is open to patients no matter where they live.
Providers are reimbursed each month per patient for coordinating their care. This potential revenue is in addition to other services, like office visits that the provider bills for. In order to be eligible for this reimbursement, the provider must document at least 20 minutes per month in non face-to-face care of patients.
Video visits are an ideal way to provide and document the service at the same time. Under the Chronic Care Management program, the patient does not need to be at an originating site, making this an ideal service to provide while the patient is at home.
All state Medicaid programs cover telehealth to some degree, but each has a different set of rules and requirements. Some have originating site requirements like Medicare, while others do away with this limitation in favor of letting patients use telehealth solutions at home.
Right now, reimbursement for telehealth is unfortunately complicated. There are telehealth technologies that help you sort through it and schedule video visits for eligible patients. Change is coming, however. All signs point to a future of better telehealth: how patients are treated and how providers are paid.
Telehealth for Specialists
Specialty care providers are an essential part of the healthcare system. Like their primary care counterparts, specialty providers are increasingly turning to telehealth as a way to provide better care to patients, expand their markets, and build more efficient, profitable practices. Here is a look at how some specialists are leveraging this powerful new tool.
Patients with congenital heart defects and cardiovascular disease often require precise treatment plans and ongoing care. Telehealth makes managing these conditions easier on both the patient and the provider.
Telehealth is ideally suited for both routine skin assessments and urgent triage needs. Today’s high-definition video systems are more than adequate for remote diagnosis and treatment of many skin problems.
Obstetricians and gynecologists are able to manage a host of conditions ranging from prenatal care, postpartum depression, and family planning using remote video and monitoring. Telehealth is especially valuable when it comes to postoperative care. Scheduling remote appointments allows doctors to provide a high level of care without placing a physical burden on the patient.
Telehealth helps providers manage patients with chronic endocrine conditions including diabetes and thyroid disease. A video visit is a great way to handle adjustments to various hormone and hypertension treatments.
Gastroenterologists are often working with patients who have chronic conditions like Crohn’s disease, ulcerative colitis, and chronic hepatitis C. Telehealth is a great option for managing the medications of people with these illnesses.
Pediatricians are able to remotely monitor and do video visits using telehealth for routine checkups and treatment of infants, children and adolescents. This allows them to be in sync with the patient’s development outside of the office.
Hematologists and Oncologists use telehealth as a way to monitor patients, adjust medications and manage treatment plans for patients with cancer, sickle cell disease, iron deficiencies, and other similar conditions.
Providers who treat patients with infectious diseases can use telehealth technologies to monitor symptom progression, adjust medications, and respond to unforeseen side effects. Doing this via video limits the risk of exposure for the provider and others in the office.
Telehealth is a valuable tool for managing chronic care patients to slow the progression of kidney disease, working to avoid dialysis and/or transplantations. Nephrologists also use telehealth to develop at-home care plans for patients recovering from kidney replacement surgery.
Patients with asthma, bronchitis, COPD and those requiring mechanical ventilation are great candidates for remote visits. Telehealth makes it easier for them to become active and engaged in their own healthcare.
Urologists are able to use remote video visits to treat patient’s chronic urinary tract disorders. They can also provide care and consulting for issues involving male reproductive organs.
As you can see, telehealth has a role to play across the spectrum of specialties. This list isn’t exhaustive, but it gives one an idea of how widespread and valuable telehealth has become.
HIPAA Compliance for Telehealth Providers
The Health Insurance Portability and Accountability Act (HIPAA) was passed by Congress in 1996 to provide the ability to transfer and continue health insurance coverage for many American workers and their families when they change their jobs.
It was also designed to reduce healthcare fraud and abuse, partially by setting industry-wide standards for health care information on electronic billing and other processes.
It also requires the protection and secure handling of specific patient health information.
The Privacy Rule and the Security Rule addresses this last point, which is highly relevant to telehealth.
The Privacy Rule
The Privacy Rule defines and governs the use and disclosure of Protected Health Information (PHI). Providers and their associates who are covered by HIPAA must develop and stick to procedures that protect and secure PHI whenever it is received, handled, transferred, or shared.
It makes no difference if the information is shared on paper, electronically, or orally. The rule provides guidance that only the minimum health information necessary to care for the patient be used or shared.
The Security Rule
The Security Rule is shorthand for the Protection of Electronic Protected Health Information. It sets the standards for securing patient data that is stored or transferred by electronic methods. It outlines three areas of protection required for compliance: administrative, physical, and technical. The rule establishes security standards for each.
The HIPAA Privacy and Security rules apply to certain “covered entities.” They include: healthcare service providers, medical clearinghouses, and insurers, including some employer sponsored health plans.
A business associate is an entity or a person that performs activities on behalf of a covered entity. Common examples are accountants, transcription services, attorneys, and some technology service providers.
Under HIPAA, covered entities enter into contracts with business associates, requiring everyone who has access to protected data to treat it with the same level of care.
HIPAA and Telehealth
The same requirements for patient privacy and confidentiality that apply for in-person visits apply to visits conducted over video. The provider has the identical responsibility to protect patient information. The storage of electronic files, video, and images needs to be approached with the same caution as one would take with physical documents.
Consumer grade services, like Skype and Facetime, do not support HIPAA compliant video conferencing because they are not encrypted. Therefore, they should never be used for any purpose that requires the use of Protected Health Information.
Telehealth Technology and HIPAA
In terms of telehealth, providers looking to remain compliant with the law should look for the following features in any telehealth technology that they consider:
• Fully encrypted data transmission
• Peer-to-peer secure network connections
• No storage of video
In addition, the technology partner should be willing to enter into a business associate agreement.
Addressing Patient’s Privacy Concerns
Patients have every right to be concerned about privacy and ask how their information will be protected during a remote clinical encounter. Providers should be prepared to educate patients about the steps that they are taking, with their technology provider, to secure their confidential information. It is important to let patients know that you’ve chosen technology designed for this purpose and that you take your obligations under HIPAA very seriously.
While it is absolutely necessary to keep HIPAA in mind when setting up a telehealth program, it is possible to embrace this powerful innovation without any risk to your patient’s confidential information.
Best Practices for Starting a Telehealth Program
Medical practices of all sizes and types are turning to telehealth as a way to generate more revenue, keep costs down, maintain customer loyalty, and provide the type of service that patients increasingly prefer.
There are a few things you can do to help make your telehealth program successful while avoiding some common mistakes. Here are some best practices.
Have Clear Goals
It is very helpful to sit down and think about the goals for your telehealth program right at the outset. You want to define clear goals with objective measurements. You might consider how you want your telehealth program to impact things like revenue, customer satisfaction, wait times, no-shows and cancellations, staff efficiency, patient retention, new patients, and any other measurements that are important for your practice.
Involve Your Staff
Telehealth will have an impact on several functions within the practice, so it is a good idea to get a number of people involved in the roll-out of your program. Consider assembling a task-force that includes providers who will be using telehealth, people who will be scheduling appointments, any available technical resources, and people from other business functions that might be able to assist. If people are engaged early and have the opportunity to help shape the program, they will feel more invested in its success.
Learn About Reimbursement Rules and Regulations in Your State
State laws and payer policies about telehealth reimbursement vary widely. Most are becoming more progressive and embracing telehealth as an important tool for meeting the healthcare needs of the public. To that end, all states have what are known as “parity” laws, requiring reimbursement for remote video visits. Unfortunately, however, there is not a consistent approach, so it makes sense to make yourself familiar with the regulations where you practice.
Decide How Telehealth Will Be Utilized in Your Practice
There is no universal telehealth utilization strategy. You can tailor an approach that meets the unique needs of your practice. It may make sense to block off certain times during the week for remote visits, or you may decide to make video visits available during times that the office is traditionally closed. One approach to increasing utilization and revenue is conducting the follow up phone calls that you already do by video. Telephone calls are typically not reimbursable, whereas video encounters may very well be.
Market the Service
It is important to make sure that your patients know that video visits are an option for them. You may want to post signs in the office, send an email, or make mentioning it a part of every in-person encounter. Even if patients don’t immediately embrace the approach, knowing that it is an option may help keep them loyal to the practice in the face of increasing competition from retail health clinics and online only providers.
Ask for Feedback
Whenever you introduce something new to your staff and patients, it is important to gather their feedback. Think about the best way for you to get the insight of both groups and integrate their best ideas into your program.
Measure Success Against Your Goals
Once you are seeing patients via telehealth, remember to check in with your goals from time to time. You may need to tweak your program or your goals after you get started. It is also important to recognize and reward your team when goals are met or exceeded.
Telehealth has the potential to change your practice for the better in a number of ways, so it is smart to introduce it thoughtfully. These best practices will help you along the path to a healthy telehealth program.
Also, be sure to checkout the American Medical Association’s (AMA) Telehealth Implementation Playbook.
Advantages of Telehealth for Patients
If you like the idea of seeing your doctor over a video conference on your laptop or smartphone, you are not alone. Sixty-six percent (66%) of patients are interested in trying telehealth. Sixty-one percent (61%) are open to using telehealth because it is faster and more convenient, while fifty-four percent (54%) said it was less costly.
Telehealth has been used in a limited way for decades, but it is only now becoming more mainstream. This is because so many people have access to high-speed internet connections and the devices necessary to perform a video visit. The approach is popular with patients due to its many advantages. Here are a few:
No Transportation Time or Costs
When you see your doctor on your mobile device or computer, you can save money on gas, parking, and public transportation. Even better, you don’t waste time traveling or risk running into a traffic jam that makes you late for your appointment, or worse, late getting back to work.
No Need to Take Time Off of Work
Speaking of work, video visits largely remove the need to take time off. You can simply schedule your visit during a break, or before or after work. You can be anywhere that offers sufficient privacy. You can comply with your doctor’s follow-up instructions and maintain your health without missing a day of work or wasting your precious paid time off.
Eliminate Child or Elder Care Issues
Many of us have the responsibility for caring for children or older adults. Finding alternative care so that you can see the doctor can be difficult and expensive. Bringing them along can be stressful or impractical. Fortunately, telehealth solves this challenge by allowing you to see your doctor while upholding your family responsibilities.
More and more physician’s practices are offering telehealth these days, so there’s a good chance that you’ll be able to see your regular doctor via video. If you can’t, but still need remote access to care, there are a number of online-only, on-demand options on the market today. They can’t treat every condition, but can tackle a wide variety of problems. Some insurance companies pay for this type of care.
Access to Specialists
Some patients who need the care of a specialist must drive long distances and invest a lot of time for each visit. Telehealth makes it possible for you and your primary care physician to leverage the expertise of specialists who are not nearby. When it comes to serious health issues, you want to consult with the best physician, not necessarily the closest.
Less Chance of Catching a New Illness
Where can you be sure to find a lot of sick people? At the doctor’s office of course. While everyone does their best to prevent one patient from catching something from another, it is always possible, especially in crowded waiting rooms. By staying home, you get the care you need while avoiding the risk of exposure and the chance that you’ll pass your illness on to someone else.
Less Time in the Waiting Room
If you choose a video visit via telehealth technology, you’ll eliminate all that time spent looking at old magazines in a doctor’s office. Even if you don’t use telehealth, choosing a practice that offers it will reduce your wait time by letting other patients be seen from home.
When you are able to see your doctor as often as you need to, without the challenges of getting into the office, you can practice better management of your medication, lifestyle, and any chronic conditions you might have.
Given this list, it is not surprising that people are seeking out healthcare providers that offer the convenience and cost effectiveness of telehealth. It is poised to have a major positive impact on the entire healthcare system, and ready to make life a little bit easier for you.
Be sure to also checkout our Patient Engagement: The Value Spectrum.
Getting Comfortable with Video Visits
Trying out a new way to see your doctor can be a bit intimidating. Your health is of utmost importance, so if you have questions about how telehealth technology will impact your encounters and your relationship with your provider, you are not alone. Here is some information that might make you feel more confident about this new option for getting the care you need.
Quality of Care
It is important to know that not every medical situation is right for a video visit. Your provider and staff know when it is safe and effective to conduct an encounter using telehealth. For those that are, studies have shown that there is no detectable difference in the ability of a provider to gather necessary information, make an accurate diagnosis, and develop a plan for treatment. In short, video visits result in the same desired clinical outcomes as in-person care when used appropriately. In fact, when used in certain context, telemedicine can actually improve patient outcomes. Here are a few examples:
• Congestive Heart Failure: Among patients with congestive heart failure, one study found that telemonitoring was “significantly associated with reductions in mortality ranging from 15% to 56% compared with patients receiving ‘usual care.’”
• Stroke: In a study to assess whether telestroke consultations were superior for decision-making purposes than telephone-only consultations, the former won out—with researchers determining that telemedicine-based consulting resulted in more accurate decision-making.
• Chronic Obstructive Pulmonary Disease (COPD): A study to assess “Using Telehealth technology to deliver pulmonary rehabilitation in chronic obstructive pulmonary disease patients” concluded that telehealth pulmonary rehabilitation was an effective tool for increasing access to services, and improved both quality of life and capacity to exercise in comparison with the traditional approach.
When Video Visits Can Replace In-office Visits
Video visits can be used to replace in-office visits in a number of ways. Examples include:
• Follow-Up Exams – Providers often recommend a follow up visit after beginning a course of treatment. These visits are important to the ultimate resolution or management of the problem. Doing them remotely makes it easier for you to comply with the doctor’s recommendations.
• Urgent Care – Both traditional practices and stand-alone clinics are starting to offer telehealth as an option for urgent care needs. Conditions such as the flu, sinus infections, urinary tract infections, and more can be effectively treated without an in-office encounter.
• Specialty Care – Telehealth makes it possible for patients to get access to the best specialist for their needs, not just the closest.
Many state legislators recognize the advantages of telehealth for patients and the healthcare system as a whole. In fact, all states have passed laws requiring private insurance companies to reimburse providers for video visits.
Many insurance companies also see the value of telehealth and pay for video visits even when they are not required to by law. Your insurance company and your provider can help you determine if your policy will cover telehealth.
Telehealth has been around for decades, but it is just now becoming more mainstream. For many patients, the approach is new, but it is also effective, secure, and affordable. If you want to eliminate travel expenses and cost, avoid missing work, and stay out of crowded waiting rooms full of sick people, why not give it a try? Ask your provider if they offer remote visits via telehealth.
Privacy and Security
You have every right to be concerned about the privacy and security of your confidential medical information. While today’s digital world offers a lot of convenience, there are risks.
Fortunately, there are telehealth solutions on the market that have been designed specifically to protect patient information and meet the strict standards of the Health Insurance Portability and Accountability Act, known as HIPAA for short.
Be sure to ask your provider if the solution they use is HIPAA compliant, and never agree to a video visit over consumer grade applications like Facetime or Skype.
Will My Insurance Cover Telehealth?
Insurance coverage for telehealth is impacted by federal and state laws as well as insurance company policies. Although some are more progressive than others, these days many state legislatures and private health insurance providers are recognizing the potential of telehealth to reduce costs and keep patients healthier.
Even the federal government is taking a new look at how telehealth might be used more broadly under Medicare. You should check with your insurer regarding how telehealth is covered under your particular policy, but here’s a general look at the coverage landscape.
Telehealth Reimbursement by Private Insurance Companies
Video visits are used by primary care practices as a way to enhance the service they offer to patients. Here are a few of the common uses of telehealth in primary care:
State Laws That Require Insurers to Cover Telemedicine
Right now, twenty-six states have laws that require private insurers to reimburse healthcare providers for services delivered through telehealth. These are often referred to as “Parity” laws. In addition, ten more states are also considering legislation to do the same.
Each law is different, but they generally say that private payers can’t take the patient’s location into account when deciding to cover a video visit, making it possible for covered patients to be at home or work during the encounter.
This guide by the American Telemedicine Association is a great way to learn more about the laws of your state. Many states with parity laws have made exceptions for certain types of insurance plans. Worker’s compensation plans and small group plans may be eligible to opt out of coverage for telehealth.
Covered Providers and Technologies
Every state with a parity law includes real-time video visits as an acceptable form of telehealth. Some also cover services provided by secure email, or store-and-forward telehealth.
In most cases, any provider who can bill an insurance company for an in-person visit is eligible to be paid for a remote one, but this is not always the case.
Some states require that a patient relationship be established with an in-person visit before the provider can bill for a video visit, but many states do not have this requirement.
Some state laws require that insurers pay the same amount for video visits done via telehealth as they do for an in-person encounter, while others leave the decision about how much the provider will be paid up to the insurer.
The good news is that even in states without these parity laws, many insurers recognize the value of telehealth and have decided to cover video visits on their own even in states that do not require it.
So even if your state does not have a law regarding telehealth, it is still a good idea to check with your insurance company to see if your appointment is covered.
Medicare has a telehealth coverage approach that is intentionally limited in scope. Its goal is to make sure that patients in remote and rural areas have access to a specialist that may not be available nearby. Therefore, patients must live in what is known as a Health Professional Shortage Area that is outside a metropolitan area.
In addition, Medicare also requires that patients go to a designated healthcare facility in order to initiate a video visit. From there, the patient and their local provider can connect to a distant specialist using telehealth technology. Video visits from home, or anywhere that is not what’s called a designated “Originating site,” are not covered under Medicare.
Every state Medicaid program offers some type of coverage for telehealth, but they are all different. Some are like Medicare and require patients to be at a healthcare facility during the visit, while others allow for visits from home or work.
It is unfortunate that telehealth coverage is so complex right now. But as more and more insurance companies and state legislatures see the benefits of telemedicine on their communities, laws and policies will change quickly to embrace telehealth.
Increasing Popularity of Telehealth
This industry has been rapidly expanding over the five years to 2020. Advances in communication technology and medical technology, such as wearable self-monitoring devices and digitized medical scans, have propelled the industry forward. Furthermore, industry growth has been supported by a healthcare system suffering from skyrocketing costs, a looming doctor shortage and an aging population susceptible to chronic disease.
As a result, over the five years to 2020, the industry is expected to increase at an annualized rate of 34.7% to $2.4 billion, including expected growth of 7.1% in 2020. Over the five years to 2025, the industry will continue to benefit from the demographic and structural factors affecting the healthcare industry, as telehealth will emerge as a cost-effective solution to meeting the medical needs of an expanding and aging population.
Existing legislation, such as the Patient Protection and Affordable Care Act, and pending legislation will raise federal support for telehealth services, benefiting patients, healthcare providers and industry operators. Additionally, future innovations will likely increase the scope and availability of telehealth services. As a result, industry is expected to increase at an annualized rate of 9.2% to $3.7 billion over the five years to 2025.
Telehealth Key External Drivers
Private Investment in Computers and Software.
The level of private investment in computers and software reflects the general implementation of information technology within the private sector. Growth in the Telehealth Services industry is largely determined by technological expansion.
For example, advancements in communications, such as mobile devices and high-speed networks, have improved audio and video transmission between patients and healthcare providers. Therefore, an increase in private investment in computers and software corresponds with a rise in the industry. Private investment in computers and software is expected to increase in 2020.
Number of Adults Aged 65 and Older
As baby boomers age and the average life expectancy in the United States increases, the number of people aged 65 and older will rise. Individuals in this group are more likely to require medical assistance, which will promote demand for telehealth services. The number of adults 65 and older is expected to increase in 2020.
Federal Funding for Medicare and Medicaid
An aging population will likely lead to an increase in the number of individuals with chronic diseases, such as congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, hypertension and end-stage renal dialysis.
For individuals 65 and older, Medicare commonly reimburses a high percentage of the costs associated with treating these conditions. As federal funding for Medicare and Medicaid increases and doctors increasingly use telehealth services for patients with these diseases, the industry will rise.
Federal funding for Medicare and Medicaid is expected to increase in 2020, representing a potential opportunity for this industry.
Check out the CARES Act funding and support for telehealth.
Number of People with Private Health Insurance
As studies continue to validate the efficacy of telehealth services, private health insurers are more likely to cover industry-related services. Therefore, increased insurance acceptance of telehealth services and a rise in the number of privately insured individuals will lead to an increase in the industry. The number of people with private health insurance is expected to increase in 2020.
Demand from Medical Device Manufacturing
Advancements in medical technology, such as wearable monitoring devices and digitized medical scans, have created new opportunities for telehealth, supporting the industry’s growth. As a result, when new devices are brought to the market and revenue in this industry expands, demand for the Telehealth services also increases.
The level and movement of interest rates have a formidable influence on spending and investment decisions. When interest rates are low, it is less expensive for nonprofit and for-profit healthcare providers to raise capital and invest in technological upgrades, including investments in telehealth equipment. The prime rate is expected to decrease in 2020, posing a potential opportunity to the industry.
Telehealth Industry Performance
Fueled by a surge in technological advances in the field of communications and a torrent of new wireless self-monitoring healthcare devices, operators in the Telehealth Services industry are currently experiencing a period of rapid expansion. Over the five years to 2020, industry revenue is expected to rise at an annualized rate of 34.7% to $2.4 billion, including an 7.1% increase in 2020 alone.
Industry operators have demonstrated that they can provide reliable healthcare to a greater number of patients at a lesser cost. As a result, the Telehealth Services industry is maximally positioned to help provide solutions for a healthcare system suffering from skyrocketing costs, an aging population susceptible to chronic diseases and a looming doctor shortage.
Telehealth Technology Advances
Technology has strongly driven growth for the industry and is crucial to its success.
Technological innovations have been implemented in a vast array of areas including patient records, disease diagnoses, consultation, treatment delivery and self-care. Technological advances have taken services from the confines of hospitals into homes; specifically, mobile health advancements have facilitated remote access for both patients and physicians.
There has been a proliferation of self-monitoring tools that enable patients to monitor conditions such as pacemaker activity, blood sugar level, blood pressure, blood oxygen level, respiration and heart rate. With these tools, patients can also remotely transmit their results to healthcare providers.
There has also been a dramatic rise in wearable devices, which were first created for consumers and sports enthusiasts but have since been developed for medical purposes. These instruments, referred to as Medical Body Area Network (MBAN) devices, can measure electrocardiogram (EKG) readings, respiratory rates and insulin levels; detect breast cancer by reading changes in cellular structure; transmit an alert if a person falls down; and detect skin pH levels though a bandage to determine if a cut has become infected.
Advancements in store-and-forward technology have enabled X-rays, MRIs, CT scans, CAT scans and audio and visual observations to be digitally stored and instantaneously shared.
Advancements in telecommunications and videoconferencing equipment have also enhanced real-time communication, letting physicians and specialists confer across great distances, promoting proper patient diagnosis and treatment.
Additionally, peripheral devices can be attached to computers, mobile robotics and other equipment to aid in diagnoses.
Direct two-way audio and video streaming between health centers has led to lower costs in these critical areas of health treatment.
Self-service kiosks have also been implemented in some hospitals. These kiosks can expedite processes such as hospital registration without having to involve hospital personnel. Automated kiosks can assist patients with copays, checking identification and other registration requirements.
Such services have helped healthcare providers save on staffing costs. However, these industry services designed to cut administrative costs represent only a small portion of the telehealth market.
Advancements in healthcare technology and the use of digital technologies to deliver medical care, health education and aid have been, and will continue to be, the primary driver for this industry.
Research Validates Efficacy of Telehealth
Just prior to the period, a 2013 analysis by the Commonwealth Fund examined findings from three early telehealth adopters: the Veterans Health Administration, Partners HealthCare and Centura Health at Home.
The study concluded that telehealth and telemonitoring reduced hospitalizations, readmissions and healthcare costs, while improving patient satisfaction and engaging patients in their own healthcare. This legitimization helped spur the industry to heightened growth during the current five-year period.
A 2010 study of tele-intensive care units (ICU) at the Massachusetts Memorial Medical Center found that 50.0% more patients could be treated at facilities with tele-ICU capabilities; these patients would otherwise require a transfer to another hospital, saving about $10,000 per patient.
Similar positive outcomes were found in other studies involving congestive heart disease, diabetes, obstetric, dermatology and psychiatric treatment. These studies and many more confirm that telehealth improves access to healthcare, boosts quality of care and increases cost efficiency.
Although the Patient Protection and Affordable Care Act (PPACA), was passed in 2010 and implemented in 2013, it has only just begun to significantly affect the Telehealth Services industry. Therefore, this legislation will provide the impetus for industry growth over the five years to 2025.
The PPACA incorporates several incentives for the industry. It directs the Centers for Medicare and Medicaid Innovation (CMI) to explore the facilitating of local hospital inpatient care by the use of electronic monitoring by outside specialists, and it lets the CMI develop patient-care models using remote-based monitoring systems to coordinate care over time and across settings.
The PPACA also permits physicians to use telehealth to determine the need for home healthcare and in-home medical equipment and directs the CMI to provide medically underserved areas with telehealth services to treat behavioral health problems and stroke patients.
Following through on these objectives, in January 2015, the Centers for Medicaid and Medicare Services (CMS) extended its coverage of telehealth services by offering seven new covered procedural codes for industry-related services. Moreover, the CMS announced it will cover remote patient monitoring for chronic conditions, under one of these new procedural codes.
Prior to this rule change, Medicare mandated that such services could only be bundled with evaluation and management billing codes. Therefore, by separately itemizing remote patient monitoring services, the CMS opened the possibility for an expansion in Medicare reimbursements for telehealth services, which will vastly expand industry over the five years to 2024.
The ACA also makes doctors and hospitals more accountable by moving medical care providers away from fee-for-service medicine, shifting reimbursement structures toward the value of care rather than the volume of services. This provision will pressure doctors and health professionals to keep patients out of hospitals, where care is more expensive.
As a result, the use of telehealth services should strongly increase, as research has demonstrated that in many cases telehealth services are more cost efficient, result in fewer hospital visits and are as effective as hospital treatment.
An Aging Population Boost Revenue
As the US population progressively ages, incidences of chronic diseases including congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), diabetes, hypertension and end stage renal dialysis are expected to rise. Accordingly, treatment of these chronic diseases will sharply accelerate the overall cost of US healthcare.
Greater demand for medical services, combined with an expected shortage of doctors, will drive demand for telehealth services.
The Association of American Medical Colleges (AAMC) has long expected a physician shortage in the United States. For example, in February 2014, the AAMC anticipated a shortage of about 130,600 doctors by 2025.
The industry is well-positioned to help alleviate this lapse in care. By incorporating telehealth services, fewer physicians can treat more patients.
Remote wearable monitoring devices, the use of smartphones and tablets to transmit self-monitored patient data and the ability of local physicians to confer with specialists remotely via videoconferencing will assist the delivery of adequate care and compensate for a physician shortage.
Legislation to Promote Telehealth Growth
While several federal bills designed to encourage telehealth services have failed in the past, many state governments have enacted their own laws designed to encourage telehealth services.
For example, in 2015, New York passed a telehealth law, which mandates that telehealth visits, including live video, store-and-forward and remote patient monitoring services must be reimbursed at the same rate as in-person visits. Moreover, private insurers in New York are required to cover telehealth-related procedures if these services are provided by hospitals, hospice agencies, licensed physicians or other similar healthcare professionals. Currently, all the states have some type of similar telehealth parity law.
The prospective for further state and Congressional support for telehealth services, combined with an increase in anticipated demand for industry services, will continue to entice new entrants into the rapidly expanding Telehealth Services industry.
Telehealth Major Markets
Congestive Heart Failure
Congestive heart failure (CHF) is a condition in which the heart is unable to pump a sufficient flow of blood to the rest of the body. Symptoms of CHF include shortness of breath, swollen legs and the inability to exercise. The condition, caused by various forms of heart disease, is typically diagnosed by a physician using blood tests and an echocardiography.
Industry operators are able to remotely monitor CHF patients from their home, thereby eliminating unnecessary visits to doctor’s offices and hospitals.
CHF is expected to account for an estimated 34.2% of industry in 2020. Over the past five years, this segment has remained relatively constant as more Americans are better at treating their diabetes, high blood pressure, high levels of stress and obesity, all of which can lead to CHF.
Diabetes is a chronic disease in which a person has a high amount of glucose in their blood. There are three primary types of diabetes:
• Type 1 or insulin-dependent diabetes is a result of the body not producing insulin and is treated with insulin injections;
• Type 2 diabetes is a result of the body being resistant to the insulin that the body produces; and
• Gestational diabetes can occur in pregnant women who develop a high level of sugar in their blood. These women have had no prior diagnosis of diabetes; however, gestational diabetes can be a precursor of Type 2 diabetes.
Telehealth services permit diabetes patients to have insulin levels monitored by their doctor from a remote location.
Diabetes is expected to account for 31.8% of the industry in 2020. Over the past five years, this segment has increased as Americans have been eating diets high in sugar.
Chronic Obstructive Pulmonary Disease
Chronic obstructive pulmonary disease (COPD) is common lung disease in which breathing becomes difficult. The two main forms of COPD are chronic bronchitis and emphysema.
While smoking is the main cause, heavy exposure to secondhand smoke, pollution and gases or fumes also place nonsmokers at risk. Symptoms of COPD include coughing, fatigue, respiratory infection and wheezing. The chronic illness is best diagnosed using a spirogram to test lung function.
COPD patients employ industry services to be monitored remotely by their physician.
COPD is expected to account for an expected 20.5% of the industry in 2020 and has been steady over the past five years due to antismoking campaigns directed toward teenagers.
Hypertension or high blood pressure is a chronic condition that occurs when there is elevated blood pressure in the arteries, typically at or above 140/90.
In the majority of hypertension cases, there is no underlying medical cause; however, a small percentage of cases are caused by other conditions affecting arteries, the endocrine system, the heart or kidneys. Those with hypertension are at a greater risk for stroke and aneurysms.
Industry companies are able to easily monitor hypertension patients remotely, decreasing the need for on-site visits.
Hypertension is expected to account for 9.3% of industry in 2020. This segment has increased during the period as Americans are eating foods high in sodium.
Mental health problems include anxiety and depression.
With telehealth, patients are able to meet with their doctors via video conferencing, in lieu of an office visit.
This segment is expected to account for 2.7% of the industry in 2020. Mental health cases have increased over the past five years as many mental health treatment costs are now covered by Medicare and Medicaid.
Other telehealth services is expected to account for 1.5% of the industry in 2020. This segment includes skin diseases, nutrition, oral health and reproductive health. Remote monitoring and conferencing with providers grant patients and doctors greater flexibility. Over the past five years, this segment’s share of revenue has declined.
Telehealth Technology and Systems
Telehealth software is developed from a fusion of audio, high-definition video, third-party medical programs and collaboration tools. The time and costs associated with this data integration process varies on the amount and complexity of data.
Furthermore, high data encryption is necessary to ensure data security. Despite the many recent strides in industry technology, telehealth services are still not to be used in emergency situations
Additionally, this industry is subject to frequent changes in technology. Adopting new technologies faster than competitors provides a competitive advantage to companies. Industry operators are vigilant in updating their products in an effort to increase interoperability and enhance data security. Failure to provide clients with improvements such as these features may result in a loss of business.
Telehealth Regulation and Policy
Software used in industry systems is subject to the Federal Health Administrations’ (FHA) standards. The industry’s computerized systems must meet broad guidelines with regard to accuracy and traceability. These systems must also meet regulations concerning data security.
Standards issued by the Health Insurance Portability and Accountability Act (HIPAA) are also relevant to industry operators. As a result, operators undertaking trial processes must comply with federally mandated standards on issues such as privacy and security with regard to a subject’s health information.
Industry operators, which are also manufacturers of medical devices must comply with the FDA’s 510(k) approval process. In this process, participants must submit data that supports what the medical device claims. Once an order from the FDA is obtained, the new device can be commercially distributed.
Products that require Premarket Approvals (PMAs), conversely, are generally devices that pose a significant risk of illness or injury. The PMA process is lengthier than the 510(k) process because PMA requires companies to independently demonstrate that a new medical device is safe and effective by submitting clinical data to support claims made for the device.
Medical device reporting regulation permits the FDA and manufacturers to identify and monitor adverse events involving medical devices. Manufacturers must report deaths, serious injuries and malfunctions within 30 calendar days of becoming aware of the event; events that may pose unreasonable risk of substantial harm to the public health within five working days from becoming aware of the event; and interim and annual updates if any baseline information changes occur after initial submission.
Telehealth is becoming big business in the United States. Because of this, there are a number of associations and advocacy groups that provide information and support to people interested in how telehealth is changing our healthcare system.
American Telemedicine Association
The American Telemedicine Association (ATA) is a pioneering international resource and advocacy group that works to promote the use of advanced remote medical technologies. ATA members want to see telemedicine integrated into the healthcare system as a way to improve quality, affordability, and equality across the world. The non-profit
organization, which was established in 1993 and is headquartered in Washington, DC, is open to individuals, healthcare institutions, companies, and others interested in promoting the use of telehealth technologies.
Center for Connected Health Policy: The National Telehealth Policy Resource Center
The Center for Connected Health Policy (CCHP) is a public interest organization that develops and distributes telehealth policy solutions designed to promote improvements in health and healthcare systems.
CCHP was initially focused only on California telemedicine policies. It’s Telehealth Model Statute Report, became the basis for the Telehealth Advancement Act of 2011, which allows California medical professionals to utilize telehealth and removes barriers to the practice of telehealth. In 2012, the organization became the federally designated National Telehealth Policy Resource Center (NTRC-P) and today, has expanded its mission to include national health policy.
International Society for Telemedicine and eHealth (ISfTeH)
The International Society for Telemedicine and eHealth is an organization determined to facilitate the “international dissemination of knowledge and experience in Telemedicine and eHealth and providing access to recognized experts in the field worldwide.”
It serves as an umbrella for national telemedicine and eHealth organizations, assisting the startup of new organizations. It has close ties to the World Health Organization and International Telecommunication Union. The organization is open to councils, associated societies, corporations, and individuals.
International Council of Nurses (ICN) Telenursing Network
The ICN Telenursing Network strives to, educate, support and collaborate with nurses and nurse supporters from across the globe who have an interest in telenursing. They work to promote nursing involvement in the development and use of telehealth technologies, with the goal of improving the timeliness, quality and access of a broad range of healthcare services.
The Office for the Advancement of Telehealth (OAT)
health information services. The OAT provides funds to promote and improve telehealth services in rural areas, including: the Telehealth Grant Network Program, Rural Veterans Health Access Program, and the Telehealth Resource Centers Grant Program.
Consortium of Telehealth Resource Centers
actively providing or interested in providing medical care at a distance. Their charter from the Office for Advancement of Telehealth is to assist in expanding of the availability of health care to underserved populations. Because they are federally funded, the assistance provided is generally free of charge.
Telehealth Publications and Blogs
Telehealth is quickly becoming a standard and mainstream way of providing care for patients across the United States. Laws and insurance provider policies are changing to increase access to this convenient and cost-effective channel for healthcare delivery. It’s no wonder then that so many people want to be part of the conversation about how this innovative approach to modern healthcare is impacting patients and providers.
Telemedicine and e-Health (An Official Journal of the American Telemedicine Association)
Telemedicine and e-Health is a leading international peer-reviewed journal covering the full spectrum of advances and clinical applications of telemedicine and management of electronic health records. It places special emphasis on the outcome and impact of telemedicine on the quality, cost effectiveness, and access to healthcare.
Journal of Telemedicine and Telecare
The leading journal in its field, the Journal of Telemedicine and Telecare helps you to stay up-to-date in this fast moving and growing area of medicine. Contributions from around the world provide a unique perspective on how different countries and health systems are using new technology in healthcare. This high-quality scientific work provides excellent coverage of developments in telemedicine and e-health with a focus on clinical trials of telemedicine applications.
Telemental Health Institute Blog
The Telemental Institute is a non-profit institute designed to research and develop evidence-based training materials and resources; offer free webinars to the behavioral professional community; consult agencies wishing to start-up their own telemental health programs; credential providers and provide other support services as the professional community increases health care access to more patients via digital health. Their blog covers strategic planning, reimbursement, technology choices, legal and ethical risk management and staff development/placement.
Healthcare Informatics Blog
Healthcare Informatics serves as the leading source of information for forward-thinking professionals involved in the planning, development, and implementation of important technological trends that define tomorrow’s healthcare. Telehealth is one of these trends, and their telemedicine blog covers issues from market conditions to changing laws and payer policies.
To help better understand the subject of telehealth, we’ve compiled a list of some of the most common (and least understood) terms in the field.
API (Application Programming Interface)
An API is software that sets the rules for two applications to send data between them. APIs are used in medical practices to connect telehealth technology to electronic health record systems, online scheduling applications, or practice management systems. This eliminates the need for duplicate data entry and reduces potential errors.
Audio-teleconferencing is simply a phone call between two or more parties. Visits using audio-teleconferencing without a video component are usually not covered by insurance.
Encryption is a method of encoding data in an email message or on a webpage that makes it so the information can only be retrieved and decoded by the person or computer system authorized to access it. Secure telehealth software uses encryption to protect patient privacy related to video transmissions and other data.
HIPAA (Health Insurance Portability and Accountability Act)
HIPAA is United States legislation, enacted in 1996, that provides data privacy and security provisions for safeguarding medical information. HIPAA is important to telemedicine because its Privacy Rule and Security Rule govern how providers and their business associates must protect the confidential health information of patients.
Peer-to-Peer Networking is a type of internet connection that hides the identities and locations of all participants. This reduces the chance of accidental or intentional unauthorized access to data. Peer-to-peer networking is used in telehealth to protect patient confidentiality.
Real-time communication involves “the capture, processing, and presentation of data at the time the data is originated.” In other words, the participants interact exactly as if they were in the same room. A telephone call or live video conference involves real-time communication.
Remote Patient Monitoring
Remote patient monitoring (RPM) uses digital technologies to collect medical and other forms of health data from individuals in one location and electronically transmit that information securely to health care providers in a different location for assessment and recommendations. This type of service allows a provider to continue to track healthcare data for a patient once released to home or a care facility, reducing readmission rates.
SaaS (Software as a Service)
SaaS is a method of delivering software in which the software resides on hardware controlled by the vendor. Users access it via a web browser or mobile application. This method of software delivery puts the onus of maintenance on the vendor, rather than the customer and reduces the time and cost it takes to get started. You may hear this referred to as cloud-based, or internet-based software.
Store-and-Forward or Asynchronous Communication
Store-and-Forward, also known as “Asynchronous Communication,” is a two-way communication with a time delay between when a message is sent, when it is received, and when a response is communicated. Email is a great example of store-and-forward. In telehealth, secure email is used to send test results, or images for a specialist to review,
Telehealth refers to clinical and non-clinical services provided at a distance. It includes provider training, administrative meetings, and continuing medical education and clinical services. According to the WHO, telehealth serves, “surveillance, health promotion and public health functions.”
Telemedicine is a subset of telehealth that is related only to the provision of clinical healthcare services and education remotely, through the use of telecommunications technology. Telemedicine technology is frequently used for primary care, the management of chronic conditions, medication management, specialty care, mental health services, and other clinical care that can be provided effectively using secure video and audio connections. Telemedicine and telehealth are often used interchangeably, but there is a distinction.
Telemonitoring is the use of audio, video, and other telecommunications and electronic information sharing technologies and devices to monitor the condition of a patient remotely. Telemonitoring can be used to track a patient’s heart rate, activity, or blood sugar levels, for instance.