Any healthcare consumer unfamiliar with telehealth, telemedicine, or telecare before the pandemic certainly could explain this ever-present care option now. What they might not know is that these words describing a long-distance provider-patient connection come from the Greek word “tele” meaning “far off,” and “medicine” from the Latin word “medicus” for physician.
Through the care choices they're making today, patients, healthcare providers, administrators, and payers are shaping the future of telemedicine. symplr dives into its legal definition, coverage issues, and its evolving role in medicine.
What's the legal definition of telehealth?
According to the Center for Connected Health Policy (CCHP), U.S. states differ in how they define telemedicine and telehealth. In some states, both terms are explicitly defined in law and/or policy and regulations. More broadly, telehealth is used as an umbrella term, while telemedicine is used to define the delivery of care and services using telecommunication technologies. CCHP states that, "Additional variations of the term, primarily using the 'tele' prefix, are becoming more prevalent....and sometimes states use one definition that applies to Medicaid, private payers, and professional regulation; while other times states have separate definitions for each."
What are types of telehealth?
Telehealth offers more than convenience in connecting patients with providers. COVID-19’s effect of restricting physical contact showcased telehealth as a high-quality, efficient, and cost-saving means of initial, or total, care for non-emergent conditions. Moreover, data shows an overwhelmingly positive reception of remote care by patients and remote patient monitoring by providers.
Examples of the types of telehealth technologies and software used to deliver care include:
- Live video conferencing
- Interactive voice response (IVR) systems
- Mobile health apps and mobile health devices
- "Store and forward” electronic transmission
- Remote patient monitoring devices
How does coverage for telemedicine work?
More services became billable under telehealth codes during the COVID-19 public health emergency (PHE) to connect patients with the care and services they needed. The Centers for Medicare and Medicaid Services (CMS) used a combination of emergency authority waivers, regulations, enforcement discretion, and sub-regulatory guidance to ensure access to care, including telemedicine. Some waivers will end when the PHE is declared to be over, because they were intended to address the extreme circumstances of the pandemic and not become permanent regulations.
Some waivers, however, are here to stay. For example, CMS added coverage for remote therapeutic monitoring services in its 2022 Physician Fee Schedule final rule. This action underscores the continuing trend of expanded Medicare reimbursement for remote care monitoring. There are five new “remote therapeutic monitoring” codes, all of which were live as of January 2022.
Before the pandemic, Medicare, Medicaid, state insurance commissions, insurance carriers, and healthcare institutions each used their own unique definitions of telehealth and telemedicine. Presumably, such differences will remain when the PHE ends. As a result, it’s best to ask a few clarifying questions before embarking on a telemedicine discussion:
- Who is providing the care and from where? A physician, nurse, or other practitioner—and from a hospital, clinic, or other?
- What type of device is used? An educational video, live chat, mobile app, audio, email, or other device?
- How is care provided? Real-time or pre-recorded information?
- What type of data is used? Lab tests or images? Bio-metric app data? Digital imaging?
Once you’ve established the who, what, from where, and how medical care is provided, make sure you step back and remember the big picture. Read on for non-insurance issues related to telemedicine.
Non-coverage telehealth issues providers must address
Healthcare organizations that are remapping their approach to telehealth should ensure that their decisions cover provider address coverage, of course, but there's much more to strategize about including:
- Care efficacy
- Provider credentialing, privileging, and training
- Patient/member engagement
- Privacy issues
- Ethics, especially as related to prescriptions
Even the information technology capabilities of the health system for telehealth should come under scrutiny.
The goal of telemedicine, no matter its definition, is to improve patient care. According to the American Telemedicine Association, there are four primary benefits that support this goal:
- Improved access: Millions of patients are no longer dependent on geography to receive care. Routine and specialized health care comes to the patient, no matter how remote their location. Physicians and health facilities aren’t restricted to an office and can dramatically expand their reach.
- Cost efficiencies: Telemedicine has inherent cost advantages to both the patient and provider, by reducing costs and improving efficiencies in the delivery of care.
- Improved quality: Patients can now access quality services that address everything from mental health to acute and chronic conditions, with a high level of patient satisfaction.
- Patient demand: Patients are willing to participate in their own care. Specialized providers and services are readily available, often with convenient scheduling.
What to watch: States' telehealth reform
Healthcare organizations are wise to watch states’ next moves as the terrain around telehealth coverage shifts and makes compliance more complex. Regulations at the state level are a patchwork, and the landscape at the federal level is still forming. CMS’ decision to make permanent changes to some Coronavirus-era telehealth flexibilities supports the ability to make some policy changes now, and remain in compliance long term.
However, watch these key areas for changes in states’ positions on telehealth:
- Cross-state licensing
- Prescribing
- Defining the patient-physician relationship
- Written informed consent
Each presents hard-to-navigate state licensing requirements and the potential for missed timelines that create provider customer service issues.
Telehealth: Here to stay
Telemedicine is here to stay and might come even closer to home. Alexa can now call your doctor. Artificial intelligence is being used to develop face-reading algorithms to diagnose diseases, and elder-care assisting robots are under development. Telemedicine will continue to rapidly evolve to improve care to all types of patient populations.
Healthcare providers are rapidly reaping the benefits of telemedicine advances. More medical education programs are including curriculum that aids providers in the delivery of telehealth. Providers now have access to a comprehensive data set that goes far beyond previously available information, resulting in more effective treatment plans. Centralized data banks now include patient visits with all care providers, including specialist visits, pharmacy records, and daily biometric data.
With greater access and quicker availability, even the most chronic conditions can be rapidly addressed before the patient visits a doctor or is admitted to a facility. Medical centers benefit from lower costs to treat even the most complex cases, while increasing patient satisfaction and lowering length of stay.
Fortunately, symplr can help your healthcare organization capitalize on telehealth opportunities through our provider data management, CVO, and quality solutions.
