Best Practices in Telemedicine

The Centers for Medicare and Medicaid Services (CMS) is on a mission to modernize Medicare reimbursement policies. In tandem with multiple movements, the regulator is expanding coverage of virtual care services, in essence acknowledging what the majority of healthcare providers already know: telemedicine is a viable option for quality patient care.

In a press release announcing what it dubbed as “proposed historic changes” that would “restore the doctor-patient relationship,” CMS underscored the challenges some beneficiaries face in seeing their physicians and the role that innovative technologies like telemedicine play in expanding and improving access. By enabling remote provision of services, patients naturally connect with their physicians faster, driving more proactive, consistent care. If approved, the telemedicine provisions in the proposed 2019 Physician Fee Schedule include reimbursing clinicians for virtual check-ins and for evaluation of patient-submitted photos. Medicare-covered telehealth services would also be expanded to include prolonged preventive care.

This move to expand services eligible for Medicare reimbursement is expected to accelerate the already-rapid pace at which telemedicine is being adopted. According to the American Telemedicine Association (ATA), over half of all U.S. hospitals now use some form of telemedicine. In many cases, hospitals are using commercial clinical service providers that handle a suite of telemedicine services, such as teleradiology, tele-cardiology and video consults. An examination of the clinical examination component of telemedicine, published earlier this year in Medical Clinics of North America, also found that many hospitals have implemented tele-intensive-care-unit services that continuously monitor patients and alert on-site providers to emerging issues. These services, noted the authors, are particularly beneficial to rural hospitals because they allow patients to remain on-site and with their families and also reduce overall costs.

A survey from Sage Growth Partners (SGP) found that telemedicine is most commonly used for emergency cases in hospitals (20%), remote patient home monitoring (21%) and non-emergency hospital cases (20%). The report, Defining Telemedicine’s Role: The View From the C-Suite, also found that 69 percent of healthcare executives surveyed want to see telemedicine in outpatient clinics. While a significant majority (79%) believe telemedicine will contribute to less than 15 percent of their total revenue in three years, most also expect to see positive ROI within three years in the outpatient clinic (75%).

Achieving such ambitious goals is not without certain challenges. According to the Medical Clinics of North America study, provider organizations that offer telemedicine services will soon be competing with commercial services that have thousands of telehealth workers on-call and housed in virtual call centers. These clinicians are licensed in multiple states and can practice in multiple time zones seven days a week. There are also concerns over “the increasing fragmentation of health care services, the slow (but increasing) rate of acceptance of telemedicine by physicians and other key decision makers, and the need for champions of telemedicine to drive acceptance forward.”

Success requires a well-designed and properly implemented telemedicine program that brings together the right solutions with carefully constructed processes that accelerate clinical workflows instead of dragging them down.  The American Medical Association (AMA) STEPS Forward™ program, a practice-based initiative providing physicians with proven strategies to improve practice efficiency, includes a telemedicine module with practice guidelines to help physicians initiate a successful telemedicine service model:

  • Understand and comply with all state and federal regulatory requirements: Telemedicine is governed by a complex regulatory environment, so it’s important to understand all state and federal laws and relevant state licensure and prescribing regulations.
  • Identify the service model that is the best fit for the practice and its patients: There are many service models that can be adopted into any given practice, including direct patient care for evaluation or serving as an originating site to connect patients to other physicians or to connect to other providers and offer services through store-and-forward applications.
  • Determine the technology and support needed while following all applicable privacy laws: This includes understanding requirements for the services to be provided, using only HIPAA-compliant technologies and entering appropriate Business Associate Agreements, properly encrypting data and using interoperable devices.
  • Follow appropriate specialty clinical practice guidelines: Check first with appropriate medical specialty societies and state medical associations to identify any specialty- or state-specific policies, guidelines and resources that have already been developed.
  • Follow technical guidelines where appropriate: To avoid mistakes, base technology selections on factors that include budget, any specific imaging needs and any impact telemedicine may have on existing vendor contracts, or vice versa.
  • Ensure appropriate sustainability models to support the types of telemedicine services offered: Make sure the telemedicine service module ultimately deployed offers HIPAA-compliant remote consults that protect patient privacy. Identify how physicians should bill for telemedicine services and ensure that the practice can support doing so. Finally, make sure the practice can stay current on new regulations as technology evolves.

By leveraging existing resources like the AMA’s guidelines and toolkits available from the ATA to implement telemedicine programs, physicians can expand their patient access without further straining available resources.

Sign up for News and Updates.