Nov 05 2018

When It Comes to Telehealth, Embrace Complexity and Ambiguity

To get to a 24-hour care model, the industry needs to first address reimbursement and other issues with virtual care.

Six words from a discussion with a healthcare CEO have stuck with Krista Stadler, St. Luke’s Health System’s senior director of telehealth services, for 14 years: “Passion for complexity, tolerance for ambiguity.” She wrote the phrase on a sticky note and has kept it on her desk ever since.

“That is telehealth in a nutshell,” Stadler says. “There’s no book out there, and even if there were, it would be outdated in two months because it’s a rapidly evolving environment.”

Stadler ticks off a list of challenges:

  • Scheduling visits with remote physicians and patients
  • Adapting workflows for clinic nurses
  • Prechecking equipment to ensure it’s fully operational
  • Managing health records
  • Establishing compliant billing policies and consent processes across facilities
  • Guaranteeing compliance with HIPAA

“Technology, although complex, is the easy part,” says Stadler. “It is the building of processes that support the use of the technology that provide an additional level of scrutiny to ensure a safe, compliant and reliable program for the patient and provider.”

Indeed, telehealth adoption is still relatively low, with the College of Health Information Management Executives (CHIME) annual Most Wired survey, released earlier this month, finding that just 38 percent of the 600 IT executives surveyed are using their patient portals to conduct virtual care visits.

“While this may seem low compared to adoption of other capabilities, it is actually high given that virtual care is still developing and few patients have participated in it,” the report notes. “The progress of virtual care may indicate that the industry is approaching around-the-clock connectivity as telehealth enables clinicians to provide more direct, more accessible care.”

But this picture of 24-hour care won’t materialize until some of the more stubborn issues plaguing telehealth are tackled.

MORE FROM HEALTHTECH: Millennial expectations are pushing the shift to virtual care!

Reimbursement Proves a Top Challenge for Telehealth Programs

One of the most complex issues is reimbursement. MainStreet Family Urgent Care, in Alabama, is in the planning stages for rolling out what it refers to as micro clinics in more far-flung areas of the state. Standard clinics have five or six exam rooms, two or three medical assistants and a nurse practitioner; by comparison, the micro clinics will be about half that size and employ just a registered nurse trained to conduct diagnostics such as X-rays and lab tests, print prescriptions and otherwise facilitate instructions from a remote physician.

The challenge, however, is getting insurance or Medicaid coverage with no provider onsite.

Cost is a huge factor,” says Betsy Stewart, MainStreet Family Urgent Care’s marketing director. “It’s basically what’s limiting us.” MainStreet is considering making micro clinics a self-pay option, but that’s particularly difficult in the economically depressed rural areas that the clinics aim to serve.

As a Telehealth Center of Excellence, the University of Mississippi Medical Center is working to create a standard of best practices and build the research body around telehealth.

“We’re trying to find out what works, what doesn’t work, how people can grow these programs and build programs that really work for the patient,” says Michael Adcock, executive director of UMMC’s Center for Telehealth.

For more on how healthcare organizations are tackling telehealth challenges, check out our feature: Technology Helps Providers Go the Distance to Bring Care to Rural Patients.

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