As healthcare providers continue to explore ways to improve care, they are increasingly relying on technology. Telemedicine is not new in the healthcare industry, but its role in provide care and expanding access for patients is increasing.
Before discussing all the ways that telemedicine can benefit patients and a healthcare practice, it’s important to step back and understand exactly what it is. The most basic definition of ‘tele’ in telemedicine is medical care from a distance. Your older patients might view this as medicine through a TV – and they’d actually be correct. Telemedicine, therefore, becomes the action of providing care to someone who is not in the same physical location as the provider. (Lots more about this later on.)
This distance care expands access so physicians can ‘see’ patients who are unable to physically go to a doctor’s office or medical clinic. It allows providers to discuss symptoms, diagnose medical issues, identify appropriate treatment, and prescribe medication through a video interface.
When Alexander Graham Bell invented the telephone in 1876, medical professionals immediately identified the potential of this new technology. In the early 1900s Dr. Hugo Gernsback envisioned a device that would allow doctors to examine a patient using robotics and a camera. Unfortunately, the technology wasn’t advanced enough to make his vision a reality.
However, by the 1950s doctors were experimenting with closed-circuit televisions during treatment. In the 1960s NASA invested in remote technologies for physicians to provide care to astronauts in space. That technology started making its way into mainstream healthcare back on Earth as televisions became a staple in American homes, camera and telecommunications technology advanced, and the modern-day internet came into existence. By the late 1990s the Centers for Medicare and Medicaid Services (CMS) officially recognized telemedicine as a reimbursable service. At the time it was primarily for people living in rural and underserved communities.
The adoption of telemedicine increased after the turn of the century as tools like high-speed internet, high-definition video platforms, and smartphones with cameras have become commonplace.
Telehealth is a broader term that refers to both clinical and non-clinical services accessed through technology. It can and does include some remote patient care, as well as:
Telemedicine refers more specifically to clinical or diagnostic care provided through a telecommunications platform when two people are not in the same location. Telemedicine can be one-to-one or one-to-many as in the case of group therapy or a single patient and provider joined by family members or specialists. With telemedicine, no longer are we bound by state lines, pandemics or rush hour traffic.
Today most telemedicine is done over video chat platforms, but it can also be over the telephone. In behavior medicine, such as mental health, therapists prefer the term teletherapy.
There are still a wide variety of activities that fall under telemedicine:
Adults ages 18 to 64 living in rural communities are more likely to have chronic health conditions and risk factors like obesity and smoking. They also have barriers like long travel distances and a shortage of providers that prevent them from getting necessary care. Those living in metropolitan areas could more easily find a healthcare facility or provider nearby, but had difficulty affording care.
Telemedicine can address both access and affordability for patients. It can also help providers and clinics tackle high cost of care. It creates an affordable option for patients who might otherwise end up in an emergency room, even for non-emergency issues.
One of the most promising aspects of telemedicine is its ability to deliver care to underserved populations. Telemedicine appointments allow people to see a licensed healthcare professional anytime from anywhere. This dramatically increases access for people who:
With better access, patients are more likely to seek preventive care. They can address concerns early, before they become serious conditions that are difficult and expensive to treat. This improves patient outcomes and patient satisfaction, while improving individual health and population health.
Another great benefit of telemedicine is its ability to reduce the cost of care. Adding more in-office patients to your clinical schedule might require longer clinic hours and more costs for staff time. But you can often add one or more telemedicine visits to a schedule without dramatically increasing overhead costs. Squeezing in a telemedicine visit in the morning before your other appointments, at lunch, or even after hours increases revenue without any added costs.
Patients can also benefit from lower telemedicine costs. The average cost of a virtual visit is considerably less than urgent care visit, and dramatically lower than the emergency room. Offering affordable and convenient care to patients increases the chance they seek out care, avoiding emergency rooms except in the most serious situations.
Telemedicine offers a lot of potential to expand access to care and improve patients’ and providers’ ability to manage and monitor health with a more complete and continuous picture of what is happening with a patient (rather than just a point in time when the patient is in a clinic for an appointment). However, telemedicine is not appropriate in every situation. In-person care is still required in many instances, especially emergency and acute care like heart attack, stroke, broken bones, and stitches.
While telemedicine offers a lot of potential to help both patients and providers, there are still challenges for clinics that adopt this technology.
One of the biggest barriers for most clinics is compliance with federal regulations and laws. HIPAA – the Health Insurance Portability and Accountability Act – regulates the way healthcare facilities distribute, share and safeguard patient data (among other things). You must protect patient data, so when you move care online and transfer more patient information electronically, it requires a higher level of encryption and security.
Telemedicine is growing and changing rapidly, and lawmakers are struggling to keep up. That creates challenges for healthcare providers ready to embrace technology. You may run into regulatory concerns that prevent you from providing care in a certain way, or technology vendors that don’t understand or comply with HIPAA. You must be able to prove that you and all your vendors are HIPAA compliant, or risk serious fines and penalties.
RegulationsTelemedicine laws vary from state to state, so the exact regulations you must comply with depend on where you practice medicine. Licensing rules may prevent you from treating patients across state lines. Rules on reimbursement rates and laws for patient consent to receive care electronically also vary. In recent years CMS and DHS acknowledged some of these challenges and are working to remove barriers wherever possible.
Whether you are just starting with telemedicine or you plan to expand your telemedicine offerings in the near future, understanding all the federal, state, and local laws is critical to avoid legal trouble.
One of the most critical parts of a telemedicine is the software platform you choose. There are hundreds of software vendors out there, but they are not all created equal.
As you evaluate which software is going to work best for you:
Once you decide on the right software solution, the next step is to address provider licensing. Familiarize yourself with state and local laws. In some cases physicians may need to be licensed in each state, which is costly and time-consuming. But taking those important steps can avoid serious legal issues down the road.
It’s important to understand how reimbursements work for telemedicine. Some states have “parity laws” to pay the same rate as in-person visits, but that is not a national standard. Individual payors set their own rules for telemedicine visits and the reimbursement rates for each type of visit. Clinics with internal medical coding and billing staff need to understand how to properly code telemedicine visits to maximize reimbursement rates.
Your providers and staff are probably already familiar with HIPAA laws and regulations. As you adopt new technology, it’s still a good idea to train everyone on how those laws affect telemedicine care. You may need to revamp your clinical space to include an area where providers can see patients virtually that is secure and HIPAA compliant. For example, creating a separate office with controlled access that eliminates the chance of someone seeing or overhearing a telemedicine visit.
An additional consideration is to ensure you and your technology partner(s) have a Business Associate Agreement (BAA) in place. This document outlines vendor responsibility for protecting patient data. You also need to ensure a secure and fully encrypted network is in place for all communications and data transfers. The more reputable technology providers will be able to share their safeguards. The key here is not to cut corners and put yourself at risk with the many “free” apps and services that are not designed for healthcare.
The year 2020 marked a big change in telemedicine adoption. The COVID-19 pandemic forced patients and providers to rethink the way they provide care. At the same time, patients are increasingly interested in the convenience and access that telemedicine can provide. These forces are pushing healthcare providers to adopt virtual options. Clinics and providers that want to remain competitive in attracting new patients will need to have telemedicine available moving forward.
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Jed Shay, MD
The Pain Care Center
Keith Berkowitz, MD
Center for Balanced Health
Estaban Lavato, MD
La Loma Medical Center
Raju Raval, MD
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