If skeptical on telemedicine, 'don't give in to the fearmongering'

BOSTON—Telehealth expands the concept of reimbursement, said Nathaniel Lacktman, JD, partner at Foley & Lardner, speaking at a panel discussion at mHealth + Telehealth World on July 21.

“Do not give into the fearmongering,” he said. “People have been doing this. There are business models out there working. Do not believe that patchwork quilt presents such a high level of risk that it’s a barrier to developing a meaningful program.” Telehealth is not just a tool to enhance traditional healthcare delivery. “It can do so much more. If you start to look at it that way, you really see these business models significantly expanding.”

Lacktman said the word reimbursement connotes government payment on a fee-for-service methodology. By changing the conversation to value and revenue, “you see all these payment options.” Fee-for-service provides zero incentive for telehealth, he noted.

Anuj Goel, JD, MPH, vice president of legal and regulatory affairs for the Massachusetts Hospital Association, said his organization is working to expand clinical authority to provide telehealth. MHA is developing a statewide coalition on the topic. “We need a good core group to move the ball forward.” They are seeking business groups, provider groups and patient groups and will tie the benefit of telehealth to a statewide need. The common message is that telehealth can improve access to care, increase efficiencies in care delivery and lower overall healthcare costs.

The telemedicine program at the University of Virginia has been operating for about 20 years, said Karen Rheuban, MD, medical director of the Office of Telemedicine, and now fields 48,000 encounters a year, has 352 partner sites and 63 clinical specialties and saved patients 16.5 million travel miles in the state.

“We want clinicians to feel comfortable using technology,” she said, suggesting organizations train their workforce to support the technology but not to be technicians.

She also suggested organizations track their metrics which are “really important when you’re trying to negotiate with payers.” UVA, for example, increased the use of tPA by 19 percent through its telestroke effort and reduced by 38 percent its NICU hospital days. They also decreased their 30-day readmission rate by 43 percent. “Make a case for the specific needs in your state.”

UVA’s program is in the black, Rheuban said, thanks to revenues, contracts and grants. They are working on such goals as expanding capabilities within their own health system such as connecting patients with their own providers, building population health models, promoting UVA's centers of excellence and maximizing efficiencies in their staff. Advancing a sustainability model with Medicare reimbursement is still challenging, she said.