Our most recent blog article focused on how significant advancements in telehealth are poised to become the silver lining of the COVID pandemic. But what does that silver lining actually mean for us and what barriers are standing in the way of it shining?
BENEFITS
Reduces Healthcare Costs
Arguably, the most important benefit of telehealth is how it impacts pocketbooks. The rising cost of healthcare has been a chronic pain point in our society long before the COVID crisis. Telehealth can ease this pain in a number of ways. First and foremost, it can greatly reduce trips to the emergency room since it enables patients with non-life-threatening symptoms to be screened and treated without incurring the costs associated with a physical visit to an emergency room. Research shows that the average emergency room visit costs $1,734 and the average doctor’s visit is $149, while the average cost of a telehealth visit is a mere $79.
The savings associated with telehealth are not limited to the costs of the actual visit but also include the avoided costs of travel as well. The Oregon Health and Science University estimates that the implementation of their telehealth program has saved their patients $6.4 million annually in travel costs, such as transportation, parking, and childcare. The convenience of telehealth extends all the way to employers as it provides them significant savings since their employees do not have to take time off work for clinic or doctor visits.
Magnifies Practices’ Revenue & Efficiency
Patients are not the only group to benefit from telehealth; these services also greatly enhance the lives of healthcare providers. On average, telehealth consultations are typically 20% shorter than in-person appointments. The time the practice gets back allows its healthcare providers to expand their patient base which in turn increases the practice’s revenue.
One of the most interesting ways that telehealth helps increase a practice’s revenue is by saving space. The average clinic exam room is 100 to 120 square feet, depending on the specialty, while a telehealth room for a provider can be smaller, around 80 square feet. This reduction of space allows practices to maximize the amount of space that can be dedicated to high-value/revenue-generating procedures as opposed to standard clinic rooms. Additionally, a room dedicated to telehealth only requires a computer and a desk for equipment, saving the practice even more money on healthcare equipment.
By reducing the number of patients who physically attend appointments, telehealth also reduces the need for support areas like patient waiting/check-in areas as well as the personnel needed to staff these areas. This not only reduces the practice’s overhead and maximizes their spaces, but perhaps, most importantly in this COVID era, it significantly minimizes the number of patients and staff clustered together thus reducing the exposure to illness for everyone in the clinic.
Expands Healthcare Reach
As mentioned in our previous blog, “How The VA Can Deliver COVID’s Silver Lining,” one of the biggest benefits of telehealth is its ability to extend healthcare services to groups that previously had limited access to adequate healthcare resources. Perhaps the most notable of these groups are those who live in rural areas of the country.
Telehealth shrinks the distance and resource gaps that many rural patients suffer by connecting them directly to healthcare specialists who may not be available in their area. The ability to have regular access to specialists is even more vital for rural residents as they are more likely than urban residents to die prematurely from all of the five leading causes of death: heart disease, cancer, unintentional injury, chronic lower respiratory disease, and stroke. Rural residents aren’t the only “hard to reach” group that can benefit from telehealth’s connection abilities. Recent studies by UnitedHealthcare Group indicate that telehealth is rapidly increasing among seniors, although many technological barriers (which we will touch on later) still exist among that demographic.
BARRIERS
The technology for telehealth has existed for years, so why hasn’t there been wider adoption of these services that offer so many benefits? The problem is that there are unique barriers that have long stood in the way of widespread adoption.
Varying Reimbursement and Licensing
Reimbursement is arguably the biggest policy barrier standing in the way of widespread telehealth implementation. The problem stems from the fact that Medicare restricts which telehealth services can be billed. State Medicaid programs tend to offer more flexibility since states are free to establish their own policies and create their own reimbursement rules for private payers. The challenge with state reimbursement (which is a recurring theme) is that the reimbursement policies vary by state, which ultimately limits telehealth access geographically. Reimbursements don’t just vary by state they also vary by insurer and plan. While telehealth visits are typically more cost-effective than traditional in-person visits, doctors may bill the same rates for virtual and in-office visits. The amount a consumer actually pays out of pocket varies depending on plan details such as co-pays, deductibles, and cost-sharing requirements.
The varying regulations between states also create complications when it comes to licensing. Since telehealth services are considered to occur in the physical location of the patient, regardless of where the provider is located, the provider must adhere to the licensing laws of the patient’s state, which can be diverse and in some cases conflicting. The multi-state licensing means practitioners may need full medical licenses for both the state they live in and the state(s) where their patient(s) live. In some cases, physicians are even forced to pay steep fees just to practice across state lines. While there are ways to work around these regulations, they still cause tremendous challenges for telehealth providers and are another reason telehealth access is often geographically limited.
Privacy Worries
Since HIPAA does not have specific telehealth requirements, a telehealth provider must meet the same HIPAA requirements as in-person care, which also often varies by state. In addition to the logistical barriers that come from maintaining adequate privacy, there is also a mental barrier with many people over the privacy of telehealth. For example, older patients are one of the groups that are poised to benefit the most from telehealth, yet they are also one of the groups that tend to be the most hesitant to disclose sensitive medical information electronically, according to a senior Kaiser Family Foundation program director.
While opinions over how private telehealth services still stand as a large barrier towards adoption, many of the logistical barriers associated with telehealth privacy have temporarily been relaxed due to the COVID pandemic. For example, HIPAA privacy laws now allow the use of smartphones, video conferencing platforms such as Zoom, and messaging services like WhatsApp. The impact (whether positive or negative) that the relaxation of these regulations has on the public’s perception of the privacy of telehealth may be what decides whether or not these regulations remain permanent or are tightened after the COVID crisis is over.
Lack of Infrastructure and Adaptation to the Technology
While telehealth has the potential to greatly expand the reach of healthcare to underserved populations, it faces some significant barriers. The first is the lack of adequate infrastructure. Unfortunately, many of the populations that suffer from insufficient healthcare also suffer from a lack of adequate technology to effectively implement telehealth. For example, a 2018 Broadband Deployment Report found that only 69.3% of rural areas and 64.6% of tribal areas had access to high-speed broadband internet at an adequate level to support telemedicine services. Additionally, a recent Kaiser Family Foundation study found that 3 in 10 adults aged 65 and older don’t have a computer, smartphone, or tablet with Internet access. Even if the lack of infrastructure is addressed, there is still a significant gap in the adaptation of technology. Giving seniors or those who live in rural areas access to telehealth services offers little benefit if they do not know how to work the technology to access their services. A significant investment needs to be made in teaching our society, especially those who haven’t had access before, how to utilize these services.
The lack of infrastructure and training needed for effective telehealth is not just a patient problem, it impacts the healthcare providers as well. Even though telehealth equipment is reasonably priced compared to most healthcare equipment, it still represents a significant investment that a hospital or practice must make. Many healthcare providers are intimidated by the costs associated with purchasing telehealth software, training their staff, and, in many cases, training their patients.
BENEFITS VERSUS BARRIERS
Like so many industries right now, the future of telehealth is still largely unknown. However, the COVID pandemic is undoubtedly shedding new light on the industry’s benefits and moving it forward significantly. The extent to which telehealth continues to expand and replace traditional care in the post-COVID future will hinge not only on society’s ability to mitigate the existing barriers, but also on our ability to provide effective education on its many benefits, because a healthcare revolution of this size and complexity will require a universal societal effort.