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Ehealth and Telemedicine Are on the Rise

Insights & Ideas Team •  September 12, 2016 | Enjoying Retirement, Home and Family

If you aren’t feeling well, the idea of leaving the house can sometimes seem like too much to ask, even to go to the doctor. Now imagine that you could have a detailed consultation with a specialist, doctor or a nurse without leaving the comfort of your home. That’s what some in the telemedicine field are hoping will be possible for even more people as these services become the norm.

“We are at the beginning of a big growth period for patients being able to access good care when and where they need it,” says Gary Capistrant, senior director of public policy at the American Telemedicine Association, an industry advocacy group.

Capistrant says telemedicine (a.k.a. emedicine, telehealth or ehealth) encompasses a broad scope of care options. Some are services patients may already be using without knowing it, like electronic processing of lab tests or radiology screenings by off-site experts. There are also new mobile devices available that monitor and report a patient’s vital signs for chronic issues like diabetes and can alert medical professionals automatically if a problem arises. Other telemedicine services include consultations with a doctor, nurse, physical therapist or psychiatrist online via email or video conference. Currently, most health insurers and state laws allow these virtual consultations only with doctors you have a pre-established relationship with, but the future of the industry is moving toward a world in which you may never actually need to have an in-person meeting with your health care professional.

Capistrant and other experts stress that any consideration for new care options should be made with the consultation of a medical expert. Consulting with your doctor about services is an important part of evaluating whether or not telemedicine care would suit your individual needs and be covered by your health plan. Most patients can simply ask their doctor if they utilize telehealth services, and they can find out directly from their insurance provider if any services are available on their specific plans.

Each year more and more private insurers are adding coverage for ehealth, and employers are increasingly offering it as a benefit. A 2014 industry study by Towers Watson showed that 37 percent more employers are considering offering some form of telemedicine coverage to their employees by 2017.

Over the last decade, Capistrant says, hospital networks have also begun offering ehealth to their patients, particularly in specific fields like psychiatry and even physical therapy. “Patients are looking for new services, and technology is racing ahead,” he explains. “But we still have some hurdles to clear before the majority of Americans can take advantage.”

MedicareSimplifiedThe challenges are largely around the idea of insurance coverage and cross-state rules for reimbursement, and licensure for medical providers. Medicare itself has very limited coverage for telehealth, restricting it mostly to underserved areas primarily in rural communities. Medicare also requires patients to leave their homes to go to a nearby approved clinic to have their video consultation, somewhat diminishing the convenience. However, Capistrant says, 29 states now have laws on the books that are making it easier for patients to access telehealth services through their medical providers. While many large insurance companies are offering coverage through employee health plans, they are also offering some coverage as part of Medicare Advantage programs.

Where Medicare has lagged, Capistrant says, states are picking up the slack. “Many states are now offering telemedicine services through Medicaid,” he points out. Capistrant also says that industry advocates and organizations like the AARP and health care provider associations are working to clear barriers. “There has been an aggressive push to address barriers by passing laws that require private insurers to cover telehealth services and, in some cases, to ensure they pay the rates they would for in-person care.”

Capistrant advises that it is important for patients to ask their insurer if it will cover the services and to determine how much of the costs will be covered before engaging in any telemedical services. The Center for Connected Health Policy, a nonprofit telehealth industry group, has a map that lets people determine if services should be covered by insurance in their state.

On a national level several bills are before Congress that could remove some of the restrictions, including making it easier for Medicare to cover more telehealth services. Additionally, in its most recent strategic plan, The Department of Health and Human Services has set a goal of increasing access to telemedicine and mobile health services by 2020.

“There are lots of ways telemedicine could serve patients well,” says Capistrant. “Our challenges now are letting people know what’s available and helping create a system that helps them access it.”

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