Traditional drivers in the adoption and use of telehealth have been the shortage of providers and geographic barriers to accessing services, particularly in rural and underserved areas. The expansion of telehealth services has more recently been driven by advances in technology and increasingly the transformation of national health systems globally.
However, the scope and scale of telehealth practices to date have largely been restricted by laws and regulations that govern how telehealth may be practiced and paid for, which ultimately incentivize adoption and use, more than it has by technology factors. U.S. providers often encounter a patchwork of conflicting and disparate legal and regulatory requirements for coverage and practice as a result of an inconsistent state-by-state approach to governing how telehealth may be practiced, and the fact that the majority of payment flows in healthcare continue to favor delivery processes tied to traditional care settings.
These barriers continue to present formidable non-technical challenges to scaling and sustainability:
1. Practical Barriers Quell Telemedicine Adoption
Respondents to the American Telemedicine Association’s 2017 Leadership Survey believe that inadequate coverage and payments (71%), licensure (53%), and resistance to change (50%) more than technical elements related to bandwidth (19%) and privacy/ cybersecurity (15%) represent leading barriers to increased adoption and, as a result, are more likely to hinder accelerated growth of the industry.
Increased consumer demand for telehealth (48%) and the shift to value-based reimbursement (26%) are the top-ranked trends identified by respondents that will drive the growth of the telehealth market, compared with technology improvements (6%).
2. Broadband Access Limits Telehealth's Reach
A technology challenge in facilitating broad availability of telehealth services is access to broadband, which can be particularly acute in rural areas where the need is perhaps greatest.
The American Hospital Association reports that limited access to adequate broadband services prevents some rural facilities from deploying telehealth. AHA recommends simplifying the federal programs that support the expansion of broadband. For example, the Federal Communications Commission’s Rural Healthcare Program, which supports broadband adoption, is seen as administratively burdensome and its subsidy for remote healthcare providers is often insufficient. AHA recommends that lowering participating providers’ burden and increasing the funding cap would ensure the program meets its goal of ensuring that all rural communities have the broadband access they need.
3. Public Policy Takes a Toll on Virtual Care
U.S. public policy towards telehealth vary from state to state, with no two states alike in how telehealth is defined, reimbursed or regulated. Although Medicaid reimbursement for live video exceeds that for store-and-forward and remote patient monitoring, coverage restrictions limit the patient’s home as an originating site.
Medicare has even more restrictive geographic and originating site limitations. However, as the aging of the population drives growth in the number of beneficiaries, Medicare will be under increasing pressure from patients and their extended caregivers to guarantee access to virtual care services for the management of chronic conditions.
Other common restrictions include the types of specialty services, and providers that can be reimbursed. Private payers are not subject to the same coverage and practice restrictions, and states laws requiring parity in covered services, although not necessarily the reimbursement amount, offer private payers relatively greater flexibility in coverage decisions.
4. Lack of Funding, Regulation Keeps Virtual Visits at Bay
In the WHO European Region, a lack of funding to develop and support telehealth (71% or 30 member states) and a lack of legal regulations or legislation (42% or 18 countries) are leading barriers to implementing and sustaining telehealth interventions. There is broad recognition of the need for both national policies and strategies for eHealth, universal health coverage or national health information systems as pre-requisites.
To ensure progress and the long-term sustainability of investments, sustainable funding that is insulated from changes in the national political landscape are also needed. Another key recommendation is consideration for the development of targeted, intersectoral strategies and policies to guide national telehealth implementation.
An Essential View of Telehealth Can Overcome Barriers
Globally, barriers to the implementation of telehealth in WHO Member States are along the same lines as those reported in Europe: a lack of funding, a lack of infrastructure, competing health system priorities, and a lack of legislation or regulations governing telehealth programs.
To overcome these barriers, it has been recommended that health policies view the contribution of information and communications technologies as an essential and central component rather than an add-on for delivering healthcare services and improvements in health. More importantly, data requirements for universal healthcare need to be developed as part of a country-level integrated eHealth approach to information management.
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