The session on telehealth at The 2017 OPEN MINDS Technology and Informatics Institute earlier this week was timely. Our 2017 technology survey found that telehealth adoption by specialty provider organizations grew by more than 20 percentage points for both large and small organizations between 2016 and 2017 (see The Tech-Enabled Provider Organization: The 2017 OPEN MINDS Health & Human Services Technology Survey).
The reasons are pretty clear. There is an increase in telehealth reimbursement by all payer types, including Medicaid and Medicare (see Medicaid Coverage of Telemedicine, Medicare Telemedicine Spending Rises 28% Between 2015 & 2016, But Is Still Less Than 1% Of Benefit Spending, and Employer Health Plans Pushing Telehealth Adoption One Step Closer To ‘Ubiquity’). And there is pending federal legislation that will liberalize some of the rules even further (see CONNECT for Health Act of 2017 Introduced in Senate with HIMSS Support and Federal Legislation: HR 2550 – Medicare Telehealth Parity Act of 2017).
So it was good to hear from two experienced executives that the billing and reimbursement process for telehealth services was not as daunting as you might believe. We had the chance to hear from those two executives, Michele Kelly-Thompson, Director of Clinical Services at Human Services Center and Lori Schmidt, Director of Behavioral Health, Health Partners, during the session, Telehealth Best Practices: How To Build A Successful, Sustainable Program, this week at institute.
For both the organizations in this session, setting up telehealth billing was not much more complicated than billing for any new service line. Ms. Thompson explained that in her organization, they received the needed g-modifier codes from their Medicaid MCO and were good to go. And Ms. Schmidt noted that the biggest problem for their organization was dealing with the different requirements of multiple MCOs, such as listing two different addresses on the billing forms.
While the billing process is standard, both executives pointed out the challenges of the “crazy quilt” of state regulatory requirements. Reimbursement for telehealth services is now nearly ubiquitous across states, but some states do impose a heavy regulatory burden on organizations that want to implement telehealth. And this regulatory burden can affect how soon a program can be implemented. Ms. Thompson explained that implementing a telehealth program in her state of Pennsylvania was quite difficult and drawn out. HSC had to receive letters of approval from their county mental health department, the Medicaid MCO (which took months), and the state. By contrast, HealthPartners, which operates in Minnesota, a telehealth friendly state, had to go through almost no administrative and regulatory requirements (for more on how states reimburse for telehealth, see How Do Medicare & Medicaid Reimburse Telehealth Services?: An OPEN MINDS Market Intelligence Report).
Whether or not your organization has adopted telehealth and incorporated tech-enabled services into your service delivery system, we expect to see more of these delivery models in the near future. Major health insurers like United are investing in and expanding their consumer access through telehealth (for more, see Looking Ahead To The Era Of Configured Networks). To learn more, check out these resources in the OPEN MINDS Industry Library – An Update On Tech Adoption In Health & Human Services, What Technologies Will Change Service Delivery For Consumers With Complex Needs? and The Telehealth Market – Now & In The Future. For even more, join us at The 2018 OPEN MINDS Management Best Practices Institute on August 14 for the executive summit, Designing & Implementing Innovative Clinical Treatment Programs: An Executive Summit & Showcase.