Telehealth Beyond The Hospital

The industry of telehealth is expanding for many reasons, including increased access to technology, a demand for more affordable health services and the desire for convenient care. Research findings projected a compound annual growth rate between 2014 and 2020 of 18.4% for telehealth services.

Telehealth can reduce initial hospital admissions, readmissions, length of stay and mortality rates. By expanding telehealth services to the outpatient industry, emergency department visits are reduced, patient engagement and health management are encouraged, and the overall cost of chronic disease management is lowered.

Policy’s Impact On Telehealth For Outpatient Care

While telehealth has been primarily limited to hospitals in the past, that’s changing with the expansion of telecommunications and the introduction of new policies. Both the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 and the CMS’s Patient-Driven Groupings Model are prompting outpatient healthcare clinicians to increasingly adopt telehealth.

The CMS’s final rule is also expanding Medicare Advantage telehealth benefits as of the 2020 health plan year. With increased access to preventative and medical care outside a hospital setting, we can expect to see decreased costs for both providers and patients along with more positive patient outcomes. Virtual physician-patient visits may become the norm for senior-aged patients residing in rural areas and/or those who have a history of noncompliance with prescribed medication. That said, Medicare coverage is still limited in terms of home healthcare and tends to be directed toward rehabilitation centers and nursing homes.

MACRA’s Impact On Telehealth Utilization

MACRA is a CMS value-based payment model that provides financial incentives to healthcare providers with high-quality ratings through its merit-based incentive payment system (MIPS). The MIPS-calculated quality score is derived from the following four categories: quality reporting (50% of score), promoting interoperability (25% of score), improvement activities (15% of score) and cost/resource use (10% of score). The addition of the 2018 CMS Quality Payment Program (QPP) Final Rule promotes the increased adoption of remote patient monitoring by physicians nationwide. The inclusion of telehealth utilization as a factor in calculating incentives for healthcare providers furthers the widespread use of telemedicine practices.

Telehealth And In-Home Patient Health Education

While patient education is widely recognized as critical for hospitalized patients preparing to return home, home-based clinical care is not usually reimbursable by Medicare and most commercial insurers for more than a short time period. Therefore, patient education (such as medication management) can lack the reinforcement necessary for optimal patient understanding and retention.

Telehealth allows patients access to doctors and nurses for follow-up care without requiring an in-person at-home visit. This can reduce the number of hospital readmissions and improve the health of outpatients. Telehealth’s ability to improve the health status of outpatients has been shown in the case of diabetes management via remote glucose monitoring along with virtual diabetes education.

In its 2016 report to Congress, the Department of Health and Human Services (DHHS) noted remote patient monitoring (RPM) has been used primarily for the management of chronic illness and the use of devices such as Holter monitors tracking blood pressure to convey health-related data to patients’ physicians. This type of communication between doctors and patients allows for early detection of symptoms and intervention as well as increased patient education. The following four telehealth modalities are described in the report as the most commonly used:

Live video: Two-way real-time telehealth utilization.

Store-and-forward (SFT): Transmission of video and digital images.

RPM: Personal health and medical data collection, either real-time or SFT.

Mobile health: Use of an app for clinician-patient communication, RPM, education and/or appointment reminders.

Chronic And Preventable Disease Management And Telehealth

By properly managing chronic conditions, emergency department visits can be avoided and costs lowered. Telehealth provides a convenient and affordable outlet for those with chronic conditions to consistently manage their health.

Asthma, for example, is the most prevalent chronic childhood disease, and 2.3% of all emergency department visits among children in the U.S. are due to an acute asthmatic episode. Additionally, poorly managed asthma can turn into COPD in adulthood. Meanwhile, Type 2 diabetes, a preventable condition, is considered to be at epidemic levels in the U.S. by the Centers for Disease Control (CDC), and clinical depression, a treatable condition, affects 6.7% of adults in the U.S.

The telehealth industry is working to stop the progression of preventable and treatable diseases such as diabetes and depression by identifying those at risk and providing ongoing treatment. Telehealth offers a way to monitor high-risk patients and provide more frequent interpersonal interactions in order to intervene quickly if a complication occurs or nonadherence to the care plan is suspected. In this way, the skyrocketing healthcare costs associated with chronic disease management may be contained.

Telehealth’s ability to track daily food intake and vital signs, symptoms and self-care, accountability, and data acquisition and sharing, for both providers and patients, prevents needless chronic disorders and emergencies and reduces the cost burden associated with a lack of ongoing care. For these reasons, we can expect to see more policy changes enabling the extension of telehealth to an outpatient setting and more people turning to telehealth to help manage their chronic conditions.

Telehealth Adoption For Outpatient Providers

The adoption rates of telehealth services by outpatient care providers remained flat from 2018 to 2019. Thus, key barriers to increase the use of telehealth must be overcome. For one, many outpatient providers simply do not want to take on the expense of integrating new technologies and methods into their care.

Another major concern is reimbursement from insurance companies for telehealth services. That being said, roughly 90% of outpatient providers already practicing telehealth plan to further invest in their remote services in the next 18 months.

Despite a slow start, the telehealth industry will ultimately merge with outpatient providers. To make this transition as seamless as possible, both telehealth providers and outpatient providers will need to collaborate to not only implement the necessary technology, but ensure patient satisfaction and positive patient outcomes are maintained.