Telegraph, Telephone, Telehealth! The New Wave for Healthcare Delivery by Stephanie Fiedler01/08/2018
For many years in Rural Health Professional Shortage Areas (HPSA) or in Metropolitan Statistical Areas (MSA), Medicare has supported Telehealth services due to the lack of certain types of medical professionals in identified geographic areas. Many Medicaid programs followed suit for similar reasons although they did not require the service to be delivered in HSPAs or MSAs.
Today many commercial insurance plans are recognizing the need for Telehealth services for varying reasons including patient and provider convenience & cost efficiencies and many Medicaid plans are expanding coverage to accommodate both patient and practice needs. Recent consumer surveys have shown that over 64% of the population surveyed would be willing to have a Telehealth visits with their doctor via video and more than 50% of doctors surveyed are willing to treat patients via Telehealth. Studies by The Alliance for Connected Care, a Washington DC based advocacy group found Telehealth visits can reduce cost by over $100 per visit and that 83% of patient issues are resolved during the first Telehealth visit.
While Medicare still restricts Telehealth to HPSA/MSA areas, as of Jan 1, 2017, “Place of Service code 02” for Telehealth services was implemented by CMS. This is a small step towards acknowledging this industry shift. Medicaid programs in 48 states and the District of Columbia currently allow Telehealth in some form and each state has authority over Telehealth services for commercial plans. Twenty nine states have parity laws that require commercial plans to cover comparable coverage to in person plans, while others do not mandate the coverage, they will often be “location blind” allowing plans to cover services from the patients’ home rather than a healthcare facility as many state and federal regulations require
Before you go all in, there is some planning and research to be done:
- Decide what services will most benefit both the practice and the patients – start small – test the water
- Research your state Medicaid program and your managed care plans for state and payer policy on Telehealth services
- Decide what the “who” will provide the services, the “where” will the provider be and the “when”, what times of day or days of the week the services will likely be in demand by patients.
- Determine your investment, e.g. technology costs, training costs, billing costs, additional staff costs, marketing. etc. and model the “program before you begin.
- Enlist providers in strategy sessions – get buy-in
- Map your timelines and monitor your reimbursement as you begin to ensure you are being appropriately reimbursed
A Final Note……
There is a growing need for Psychiatry & Psychology services in the market today. Blending these services into mental health practices to integrate mental health services with primary care or other medical services enhances the overall patient experience and promotes “whole-person” wellbeing, and telehealth can be an effective modality for creating this integration.