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Urology Practice Management - December 2015, Vol 4, No 6 - Telemedicine
Mariana S-B Lamb, MS
Executive Director
Medical Oncology Association of Southern California

“Convenient, easy, secure online visits”—so says the tagline for QwikVisit.com, a HIPAA-compliant, browser-based application for provider–patient online visits.1

Healthcare is among the top economic and social problems across the globe in terms of patient access to care and affordability. The United States spends twice as much as other developed countries on healthcare, but US healthcare consumers report lower quality of care, less efficiency, and limited access to healthcare services than people in other developed countries.

The Value of Telemedicine


The aging population and the attendant chronic diseases, combined with a focus on prevention and advancements in technologies, pharmaceuticals, and treatments, will con­tinue to increase the demand for healthcare services. A 2014 study supported by the Mayo Clinic suggested that of 263 respondents, approximately 66% of patients in the United States would consider being seen by a healthcare provider online.2

The value proposition of telemedicine for providers is an increase in revenue, a reduction in overhead expenses, and improved patient satisfaction. Reimbursable visits with verifiable encounters are appropriate for low-level acute disease and follow-up visits.

Telemedicine eliminates travel and saves valuable time and money. There is a certain amount of comfort in a patient meeting with his or her provider online and receiving needed prescriptions faster. According to the 2011 Intuit Health Patient Engagement Study, more than 40% of patients surveyed would consider switching providers for the convenience of online services.3

A large selling point of telemedicine is the “second opinion portal,” in which a physician registers in a second opinion portal, providing his or her credentials and the physician’s cost for a 20-minute consultation. The telemedicine software then credentials the physician and provides access to the patient. The patient searches for providers who are currently online to request immediate consultation, or for any provider who is not currently online. The patient pays the telemedicine software company the fee for the second opinion consultation, and the software company then pays the physician, minus a service fee, for the consultation.

Cost-Savings Tools and Reimbursement

There has been a global focus on the use of telemedicine as a tool to reduce healthcare costs and bring about savings. The implementation of the Affordable Care Act has already intensified this focus, by increasing the number of Americans who have health insurance and who are looking for medical services. Telemedicine technologies offer one of the few ways to assist physicians and other providers to meet the increased demand for healthcare services without delaying or reducing the quality of the services.

There is interest in studying the ways in which collaborative healthcare can be better and more economically delivered through telemedicine. As of late, more frequently used criteria to measure best practices in reducing healthcare costs, including outsourced medical services, home-based treatment, intervention as opposed to posttreatment, integrated information technology environments, increased efficiency of healthcare resources, and reducing billing gaps, all point toward the increasing use and acceptance of telemedicine.

For many years, telehealth advocates have accused payers of being unwilling to reimburse for proved telehealth interventions, which can significantly reduce medical costs. Today, Medicare, Medicaid, and some private payers are recognizing the current and potential growth of this avenue for care.4

In its 2014 report, RNCOS Business Consultancy Services predicted an 18.5% annual growth in telehealth worldwide through 2018.5 The United States will outpace the rest of the world. It is predicted that the US telehealth market will grow to $1.9 billion in 2018, measuring an annual growth rate of 56%.5 According to a 2012 report by BCC Research entitled Global Markets for Telemedicine Technologies, US telehealth will grow 600% between 2012 and 2017, and the global telehealth market will triple to $27.3 billion.6

These facts have led to increased political activity, and the associated risk for unintended consequences of legislation and regulation. Although current legislation related to telemedicine refrains from imposing a huge burden of federal control, any service that uses telephony invites some federal role.

The greatest concern is that federal bills do not interfere with state sovereignty over the licensing of medical and allied health professionals. This has long been an obstacle to telehealth. Traditional licensing laws did not envision a physician in one state treating a patient in another state. Although telehealth advocates have long lobbied for the interstate licensing of physicians and other health professionals, this is still a point of friction, which hinders rapid adoption of telehealth.

Telehealth Coverage

According to Roeen Roashan, MBA, of the marketing research firm IHS, much of the dramatic growth in US telehealth is driven by accountable care organizations (ACOs) participating in Medicare plans and within private insurers.7 Although ACOs have different models, all of them move beyond the traditional fee-for-service payment system by implementing incentives to reduce healthcare costs while increasing care quality. New technology has the potential to increase the likelihood of success. For example, the remote monitoring of blood glucose from the home of patients with diabetes can trigger an early intervention (perhaps communication with a nurse on the care team) that can reduce the risk for the patient’s hospitalization.

According to the American Telemedicine Association, 24 states and the District of Columbia mandate that private insurers cover telehealth.8 This means that if a benefit can be delivered in person or via telehealth, it must be covered. Overall, 47 states now provide some level of Medicaid coverage for telehealth.

Although having state legislators force private insurers or Medicaid to cover telehealth is one way to guarantee revenue, this strategy is inferior to a system that provides incentives for providers to adopt telehealth on their own, to reduce costs, and to increase the quality of care.

Claims and Coding

On May 21, 2015, 2 US Representatives introduced the Veterans E-Health & Telemedicine Support Act of 2015 that aims to ease a previous telehealth rule that requires Veterans Affairs (VA) patients and providers to receive their care at a federal facility.9,10 The legislation would allow VA physicians to provide telehealth services across state lines, as long as they are qualified and the treatment is “within the scope of their authorized federal duties.”9

Medicare covers certain telehealth services, especially in remote rural areas. Although Medicare coverage of telehealth started with mental health and behavioral interventions, many oncologists have found it beneficial. The Medicare administrative contractor should be billed for covered telehealth services.4 Medicare pays the amount under the Medicare Physician Fee Schedule for telehealth services.4

Claims for telehealth services should be submitted “using the appropriate CPT (Current Procedural Terminology) and/or HCPCS (Healthcare Common Procedure Coding System) code for the professional service along with the telehealth modifier GT, ‘via interactive audio and video telecommunications systems’ (for example, 99201 GT).”4 By coding and billing the GT modifier with a covered telehealth procedure code, the provider is certifying that the beneficiary was present at an eligible location at the time the telehealth service was furnished.

For federal telemedicine demonstration programs that are conducted in Alaska or Hawaii, claims should be submitted using the appropriate CPT or HCPCS code for the professional service, along with the telehealth modifier GQ if the telehealth services were performed “via an asynchronous telecommunications system” (eg, 99201 GQ).4 By using the GQ modifier, the provider is certifying that the asynchronous medical file was collected and transmitted to the provider at the distant site from a federal telemedicine demonstration project that was conducted in Alaska or Hawaii.4

Top 10 List

According to BCC Research, the top 10 companies in telemedicine are Alcatel-Lucent, AMD Global Telemedicine, Cardiocom, Cisco, Honeywell HomMed, International Business Machines Corp, LifeWatch AG, Polycom, Robert Bosch Healthcare, and SHL Telemedicine.11

The key factor to success in the telemedicine market is the attempt to affect larger markets, such as healthcare, health insurance, home care, telecommunications, networking, disease management, e-health, and healthcare information technology. Any top 10 list is invariably subjective and is in a constant state of change, and several other telemedicine companies are currently on the rise.

References

  1. QwikVisit. www.qwikvisit.com. Accessed May 29, 2015.
  2. Gardner MR, Jenkins SM, O’Neil DA, et al. Perceptions of video-based appointments from the patient’s home: a patient survey. Telemedicine J E-Health. 2015;21:281-286.
  3. Intuit. 4 Million patients go online with Intuit Health’s patient portal. Press release; July 21, 2011. www.intuit.com/company/press-room/press-releases/2011/4MillionPatientsGoOnline/. Accessed May 29, 2015.
  4. Centers for Medicare & Medicaid Services. Telehealth Services. www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/TelehealthSrvcsfctsht.pdf. December 2014. Accessed May 29, 2015.
  5. RNCOS Business Consultancy Services. Global telemedicine market outlook to 2018. March 2014. www.rncos.com/Market-Analysis-Reports/Global-Telemedicine-Market-Outlook-to-2018-IM670.htm. Accessed May 29, 2015.
  6. BCC Research. Global telemedicine market to reach $27.3 billion in 2016. Press release; March 9, 2012. www.bccresearch.com/pressroom/hlc/global-telemedicine-market-reach-$27.3-billion-2016. Accessed May 29, 2015.
  7. Graham J. Top health trend for 2014: telehealth to grow over 50%. What role for regulation? Forbes. December 28, 2013. www.forbes.com/sites/theapothecary/2013/12/28/top-health-trend-for-2014-telehealth-to-grow-over-50-what-role-for-regulation/. Accessed October 13, 2015.
  8. American Telemedicine Association. Telemedicine frequently asked questions (FAQs). www.americantelemed.org/about-telemedicine/faqs#.VgqUBflVhBc. Accessed May 29, 2015.
  9. Representative Glenn Thompson. Thompson and Rangel introduce Veterans E-Health & Telemedicine Support Act of 2015. Press release; May 21, 2015. http://thompson.house.gov/press-release/thompson-and-rangel-introduce-veterans-e-health-telemedicine-support-act-2015. Accessed October 13, 2015.
  10. Veterans E-Health & Telemedicine Support Act of 2015, HR 2516, 114th Cong, 1st Sess (2015).
  11. BCC Research. Top ten companies in telemedicine technologies. January 14, 2013. www.bccresearch.com/market-research/healthcare/telemedicine-top-ten-companies-hlc130a.html. Accessed October 13, 2015.
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Last modified: December 29, 2015
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