If you’re active in the telemedicine world (or just paying attention to it), then you know that virtual care’s benefits aren’t always matched by its adoption rates. The potential to transform healthcare globally is there – but somehow the actual telemedicine deployments aren’t always happening where they can do the most good. Why is that?
The Federal Communications Commission (FCC) decided to find out. They’ve recently released a report produced by the Intergovernmental Advisory Committee (IAC) focused on identifying and resolving barriers to telemedicine.
The report, which calls telehealth “one of the most promising quality of life opportunities in the United States today,” looks closely at the lack of broadband access in rural areas. It also examines the lack of digital readiness in hospitals, research facilities, public health agencies and payers. Finally, it proposes ways to cross reimbursement and regulatory hurdles that are currently slowing telemedicine adoption.
Challenge: Broadband Internet
The “Digital Divide” continues to haunt rural and remote areas that could most benefit from virtual care resources. The lack of access to broadband Internet divorces these communities from not just healthcare resources but educational and employment opportunities as well, creating dead-end towns without economic hope. Consider the report findings:
- 19 million Americans lack access to sufficient home broadband service.
- 24 percent of rural households can’t get fixed broadband at all.
- Almost half of U.S. counties have both high chronic disease rates and a need for greater broadband connectivity.
- Tribal lands sometimes have the lowest rates of broadband adoption; many Indian Health Services facilities lack the bandwidth to offer virtual care.
The FCC makes it clear that broadband Internet must be funded to create an equal healthcare playing field. FCC initiatives such as Connected Care NPRM and the Rural Digital Opportunity Fund strive to bring telehealth services to patients in underserved, rural and tribal areas. This includes broadband networks that provide low latency, sufficient upload bandwidth, resiliency and reliability to support the requirements. It also includes ensuring state and federal broadband programs don’t overlap and finding innovative ways to deploy hybrid fiber along with wireless, satellite, and TV white spaces.
Challenge: Digital Readiness
Just as we see varying levels of technological sophistication in any community, healthcare organizations can be wildly uneven in their digital readiness. An urban hospital may feature state-of-the-art equipment and telemedicine-trained clinicians, but that doesn’t help the surrounding rural communities if their local clinics distrust telemedicine. Senior leadership at a research think tank or a chain of skilled nursing facilities may not understand virtual care’s value. Without top-down commitment to new care delivery models, telemedicine adoption won’t thrive where it’s needed most.
The report also noted the omission of telehealth in disaster planning, response and recovery. Virtual care can save lives when an earthquake, flood or terrorist attack has destroyed local facilities. But most first responders and disaster relief agencies haven’t incorporated telemedicine equipment and remote providers into their strategies.
Telemedicine training should be part of medical school curriculum and expected professional development for all current clinicians. Today’s patients increasingly expect virtual options, which means telehealth is transforming from a nice-to-have to a need-to-have for providers that want to keep their patient base. Military and first responder teams need to create telemedicine plans in advance, so disaster relief chains can provide care as soon as an event occurs. That includes coordinating Wi-Fi hot spots and other mobile connectivity and using the right telemedicine equipment to stay agile during evolving situations.
Challenge: Reimbursement and Regulations
Providers often complain that reimbursement rules haven’t caught up with telemedicine’s popularity. Policies vary greatly, with restrictions controlling the facility or region of the virtual service, the type of service, the modality involved, the CPT code, the type of provider and other criteria. Medicare, Medicaid and commercial payers can pay the same service differently. Licensing requirements can represent another headache when it comes to providers caring for patients in other states. Because of these hurdles, and the uncertainty around HIPAA compliance, some providers have decided to steer clear of telemedicine.
Providers can continue to lobby for more favorable payment policies but many are also beginning to use telemedicine to create new revenue streams. After-hours care, downstream referrals, patient acquisition and other strategies are helping healthcare systems make telemedicine profitable. It’s also worth noting that reimbursement has changed for the better over the last few years. Foley’s recent 50-State Survey of Telehealth Commercial Payer Statutes report even states, “We predict that 2020 will yield more states enacting new telehealth insurance coverage and payment parity laws or amending current laws to better account for the current state of telehealth.”
To tackle licensing, some providers participate in the Interstate Medical Licensure Compact that allows them to become licensed in member states. However, the FCC recommends that payers and federal and state programs revise and simplify reimbursement, licensing and credentialing policies for fair payment and easier multi-state service.
Unlocking the Telehealth Advantage
Despite all of the aforementioned obstacles, telemedicine adoption has risen dramatically in recent years. One JAMA study found virtual visits increased 261 percent between 2015 and 2017, with 7 million people estimated to have received remote services in 2018. Virtual care isn’t just popular with patients and providers; it’s proven its clinical value. But to unlock its full benefits for everyone, we need to see more changes across the healthcare ecosystem from a policy, educational and infrastructure standpoint. We already know the future is virtual. There’s no point in waiting for telemedicine’s advantages to trickle down when leaders have the power to unleash a tidal wave of positive change today.