Uncertainty in the legal and regulatory landscape. Lack of HIPAA enforcement. Little interest in fraud from the OIG. State licensure statutes that were written long before the technology for telehealth existed. Risks to quality healthcare. Plus, the changing expectations from patients as consumers.
The rapidly growing telehealth industry is replete with challenges – and opportunities, which was the focus of a URAC-sponsored webinar, Challenges and Outlook for Telehealth in the Changing Healthcare Economy, on October 26, 2016. URAC Vice President Deborah Smith moderated the discussion with Adam Romney, partner at Davis Wright Tremaine, and Robert Bernstein, MD, vice president for clinical affairs, Carena.
Reimbursement has been challenging for telehealth providers. But the Centers for Medicare and Medicaid Services (CMS) seem to be “testing the waters” with a broader, liberal payment policy, Romney said.
For example, under the Bundled Payment for Care Initiative, CMS waived the geographic area requirement for telemedicine services. CMS also waived the geographic area requirement and the originating site requirement for Next Gen ACOs. And under Comprehensive Care for Joint Replacement, CMS waived the geographic area and originating site requirements, and established new G-codes for home telehealth care. Also, the emergence of telehealth parity laws is making reimbursement frm commercial payers more predictable.
Because of the uncertainty from a regulatory and legal perspective, “we’re all gazing into the crystal ball to try to predict how to deliver and practice telehealth in a legally compliant way,” said Romney. “You have to think of the full gamut of legal regulatory issues. Telemedicine does touch on every legal topic. You have to reconsider whether the fact that you are delivering the service virtually changes your regulatory or legal analysis at all.”
Beyond legal issues, telehealth providers need to take precautions to avoid emerging quality challenges. Dr. Bernstein, a pioneer in creating and advancing standards for delivery of quality virtual care, explained that patients bring consumer expectations to healthcare. They view telehealth as a transactional relationship – coming to it with more of a fixed agenda. So you have to think about how you are marketing the programs, Dr. Bernstein explained, to ensure you are not reinforcing the transactional relationship. Plus, if clinicians are incentivized on volume of patients, this coupled with the transactional expectation, could lead to bad outcomes for the patient.
Dr. Bernstein emphasizes the importance of getting telemedicine integrated into the rest of healthcare delivery to its success and growth. Clinical oversight is a key reason that integration is needed. The health systems with which Carena’s telehealth programs are integrated, for example, “have the ability and resources to assess quality and issues of overtreatment and undertreatment,” said Dr. Bernstein.
“Once you have these pieces in place for record sharing and communication, it really opens the landscape for a lot more opportunities with patient-initiated care,” said Dr. Bernstein. “You can begin implementing and integrating this delivery mode into other service lines and clinical applications.”