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Why don’t more providers use telehealth services?

December 13, 2018


Telehealth, according to the Health Resources Services Administration, is the use of electronic information and other telecommunication technology to support clinical health care given from a distance. While it has sometimes been used interchangeably with telemedicine, telehealth covers a broader scope of services than the more narrowly-defined telemedicine.

Telehealth lets clinicians monitor patients, confer with colleagues, diagnose and forward data and employ face-to-patient video conferencing. Telecommunications and other advances have given providers the ability to provide a continuum of care, especially for those patients who may live too far from many clinics or hospitals for regular visits.

Who uses telehealth?

Health Affairs reporting on the Physician Practice Benchmark Survey found that:

  • As of the survey date only 15.4 percent of physicians employed telemedicine for a wide range of patient interaction in their practices, whether through e-visits, storing and forwarding image results and monitoring patients.
  • Only 11.2 percent of doctors using telehealth used it for sharing health information between providers and other health professionals, with larger practices and specialists were more likely to use telehealth technology than smaller or general practices.
  • The AMA study found that 39.5 percent of radiologists, 24.1 percent of cardiologists and 27.8 percent of psychiatrists had the highest usage rates of telehealth: cardiologists were more likely to use it in monitoring patients, psychiatrists found it useful in videoconferencing and radiologists employed it to diagnose and store and forward data.


What are the challenges to using teleheath?

There are multiple reasons that more practitioners aren’t utilizing these technologies, but the primary ones are lack of Internet connectivity, regulatory barriers, especially those of CMS, high costs that impact smaller practices in particular, and the reluctance of some patients and doctors to try and learn new technologies. In addition, there are issues relating to confidentiality and ethics, care quality, and payer willingness to reimburse for telehealth services.

Regulatory issues and telehealth

One of the barriers to increased provider use of telehealth services are the CMS regulations affecting Medicare and Medicaid patients. Much of the blame for lack of use among older patients is due to Medicare’s rule that patients must be in an originating site when telehealth care is received. These sites must be located in rural areas with a shortage of healthcare professionals, or in a county outside of a statistical metropolitan area or otherwise participating in a federal telemedicine project to be to use telemedicine services for Medicare patients.

As of 2016 only 0.25 percent of the over 35 million fee-for-service Medicare enrollees were able to use telehealth options. Efforts by provider-advocacy groups, hospital and other organizations as well as insurers ,the CMS and Congress are underway to make telehealth seen as another modality, rather than a different type of healthcare.

Confidentiality and ethics

Measures ensuring that no one “off-screen” or otherwise unknown or not approved by the patient is able to observe without permission is necessary for preserving confidentiality and trust, as well as the importance of avoiding discrimination against patients who could be denied access due to cost or reimbursement and logistics.  Patients with transportation or mobility issues may have trouble reaching “originating sites” unless they can use mobile devices.

Quality of care

In the context of telehealth services complementing existing care delivery, measuring care quality is as important for it as for in-person visits. Concerns about depersonalizing the patient-provider relationship could be reduced by catering to a patient’s special needs and engaging with them in between regular visits.

Reimbursement issues

Problems often arise from the hodge-podge of laws and policies that currently govern payers and providers, with mandates often pertaining to coverage or reimbursement, with some patients in mandated states still having problems with payment of telehealth claims.

Commercial payers are increasingly offering reimbursement for telehealth services, with annual growth rates for covered telehealth visits increasing by 52 percent between 2005 and 2014. Not surprisingly, 2015 through 2017 saw an even greater growth increase of 261 percent. The consumer and provider interest is clearly there, once payers climb on board the telehealth bandwagon. However, telehealth parity laws and Medicare reimbursement rank among the biggest challenges currently faced by providers.

Internet connectivity, EHR integration and cost barriers

For smaller practices with lower budgets, setting up and participating in a telehealth system can be prohibitively expensive.  Even among larger practices and hospitals, interoperability with many EHR systems is often lacking.

Patient and provider attitudes toward new technology

A 2017 Modern Health study found that 82 percent of consumers don’t use telemedicine, with two-thirds of patient-responders unsure if their insurance carriers even covered it. Only one out of five were able to say for certain whether telemedicine was a covered service.

In 2017 another study by Sage Growth Partners revealed that for 44 percent of healthcare executives surveyed have not adopted telehealth programs within their organizations. 

Ways to improve provider utilization of telemedicine

  • Relaxing CMS and other payer restrictions while revising and updating regulations to match the abilities of technology and consumer demand
  • Improve health records security, patient confidentiality and other ethical guarantees
  • Work with healthcare IT developers and vendors to make telehealth technologies more affordable for smaller practices
  • Educate providers (in tandem with payers) who in turn teach patients about the cost and other benefits and correct use of telehealth services

Utilizing the services of a practice management and billing company

An experienced practice management and billing company such as M-Scribe can be invaluable when seeking guidance in using and maximizing the potential of telehealth. Adding a telemedicine option to your practice can make good sense by expanding patient access to specialized as well as routine care and improving compliance with self-care routines arising from chronic health conditions. 

Because this is a newer modality requiring knowledgeable claims billers, M-Scribe’s experienced medical claims billing and coding personnel can assist with your telemedicine-related billing, EHR integration and claims while keeping your streams of revenue steady.

Contact us at 770-666-0470 or email for more information on keeping costs down while boosting your revenue cycle.


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