The On-The-Ground Reality Of Making Telehealth Work

Executive Briefing | by | May 18, 2017


Monica E. Oss
Monica E. Oss

Our article on the relatively low use of telehealth services in federal health care programs, The Telehealth Numbers Are In – And They Aren’t Too Impressive, got some interesting feedback from our readers. Many of the comments had to do with the challenges of management teams trying to make telehealth work. John D. Young LCSW, Executive Director of Rockbridge Area Community Services, in Lexington, Virginia put the challenges in perspective:

The experience for our clinic in the Shenandoah Valley Region of Virginia has been challenging for our use of telehealth due to Virginia regulations. The reimbursement rates are low and continue to remain stagnant for Virginia Medicaid – our services continue to need to be subsidized and do not pay for the true cost. This is true, despite the state and national accolades we hear about telehealth. Fortunately we can now use physicians who are not physically in Virginia.

Even with that move to out-of-state psychiatrists, another barrier is the state-by-state licensing of psychiatry. What we need is a national license for psychiatrist (and for all medical professions). It can take two to three months in many instances to get out-of-state licensing completed for our state.

Finally, credentialing for insurance panels takes too much time and delays service delivery – and this also needs to be addressed. I think this lends itself to a national solution as well.

This topic gets way too much positive publicity when the reality is very different for those of us trying to bring this resource to our rural areas. We need robust financial reimbursement to bring telehealth to scale as it was intended.

I agree with Mr. Young – despite the rapid growth in legislation supporting telehealth (see The Telehealth Market – Now, Soon & Future and Telehealth Legislation – Filling In The Crazy Quilt), there is disconnect between the “potential” of telehealth for provider organizations and the reality of making it work from both an operational and financial perspectives.

Part of the problem – it’s proving tough to get paid. From afar, this shouldn’t seem like a problem. According to The American Telemedicine Association (ATA), 48 states now offer Medicaid coverage of telemedicine at some level, and 26 states now include telemedicine coverage in state employee health plans (see In Past Year, Telemedicine Reimbursement Has Gotten Better, Licensure Worse).

There has been recent commentary noting that the payers – who are rewarded for total care management – are getting the economic benefit of telehealth (see Telemedicine Seems To Work But Payment Creates A Disconnect and If Not Parity, Clarity – Getting Doctors Paid For Telehealth). The policy challenge is how to make telehealth administratively and financially easier for provider organizations to offer (see Who is Using Telehealth in Primary Care? Safety Net Clinics and Health Maintenance Organizations).

I think that the move to value-based reimbursement will propel the use of telehealth and other consumer technology (see From Telehealth ‘Pilot To Prediction’ and The Chain Continues – Value-Based Payment Moves To Devices & Pharma). As the use of case rates, bundled rates, and other risk-based provider reimbursement models continues to spread, adopting tech-enabled service delivery models will become an important tool. But in the meantime, coverage for telehealth under FFS reimbursement models remains a slow process (if it even moves at all) – the ability to control volume and costs in value-based arrangements can be a powerful lever if used correctly.

For more on how telehealth and value-based care are coming together, check out these resources from the OPEN MINDS Industry Library:

  1. The Latest Telehealth Example: Pay-For-Value
  2. Telehealth Licensure & Legislation Updates
  3. The Telehealth Market – Now, Soon & Future
  4. The Telehealth Market – The Future Has Arrived
  5. The Uneven Adoption Of Telehealth – The Idaho Example

And for how to build a telehealth program that can add value to your service lines, join the OPEN MINDS team on November 7, 2017 for the session, “Telehealth Best Practices: How To Build A Successful, Sustainable Program”, at The 2017 OPEN MINDS Technology & Informatics Institute in Philadelphia.


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