Two groups could give telehealth the traction it needs

No discussion about improving the healthcare system in the United States is complete without a mention of the wonderful opportunities that lie ahead in telehealth.* After all, providers and patients using technology that doesn’t depend on face-to-face communication for care delivery, monitoring or education makes so much sense.

And yet …

Telehealth is making inroads in certain areas and some pilot programs have been fruitful, but its larger promise still seems far off. The obstacles to implementing telehealth are the same ones that bedevil the entire healthcare system – fragmentation, reimbursement, licensing, outcomes, access, cost and satisfaction. While various programs have shown efficiencies, there isn’t a widely accepted body of knowledge that supports telehealth improving outcomes or bringing down costs.

Are we at a tipping point in telehealth?

Innovators have started plenty of pilot programs and ideas across healthcare, but without a clear path to provider reimbursement, there isn’t traction for wide adoption. Yet two groups could plausibly pave the way to larger-scale telehealth success.

The U.S. Department of Veterans Affairs (VA) has used clinic-based telehealth with 380,000 veterans and home-based telehealth for another 100,000 in recent years. Despite the agency’s recent problems in delivering healthcare through traditional avenues, it has the potential to innovate.

“The VA clearly has a large telehealth program, which has data to validate the impact of telehealth on a large scale,” says Amber Ford, BSN, an ABILITY clinician who has telehealth experience in home health settings. “Better yet, the VA doesn’t operate under the same payment restrictions as those who rely on reimbursement from the Centers for Medicare & Medicaid Services (CMS).”

CMS reimburses for telehealth in certain circumstances, but a fear of billing fraud has motivated the agency to keep a tight lid on what it allows. In some cases, the rules require that the patient be at a “site of care” other than their own home, such as a doctor’s office. In that case, telehealth seems to lose its advantages. There are fewer than 100 telehealth codes reimbursable through CMS.

Generational readiness may play a role

On another front, the time for change may be at hand with continuing healthcare cost pressures and the large number of Baby Boomers entering the Medicare system.

“They are the first wave of Medicare patients who are really comfortable with technology,” Ford says. “Even 10 years ago, it was different.”

As with other payment trends, it makes sense that the private insurance industry will follow the pathway that CMS paves for them. Private insurers so far have been somewhat skeptical of telehealth as many physicians expect to be compensated the same amount for a telemedicine visit as they do for an in-person encounter. If that’s the case, payers may wonder, why should they invest in building a program and network?

Telehealth attracting innovators

Telehealth has attracted a lot of technology companies sensing lucrative opportunities, but who frankly aren’t that familiar with critical barriers in healthcare. The ideas sound cool, but putting them into practice is difficult.

To work on a large scale, all parties would have to navigate issues such as reimbursement, first and foremost, and then credentialing, state licensing, privacy and liability. Could everyone agree on how success would be measured – cost savings, outcomes, patient satisfaction, access to care or all of these? Telehealth and telemedicine certainly have their place, but just how far in the future a full-scale implementation might be is a mystery.

Providers will continue to need help navigating clinical and administrative complexities as the industry evolves. ABILITY can be a steady partner during a time of profound change and uncertainty. Check out our resources here.


*Some use “telehealth” and “telemedicine” interchangeably, but telehealth is the broader term and includes clinical intervention, education, monitoring, disease management and a vast array of applications. Telemedicine is a subset of telehealth and speaks to the delivery of clinical care.