New economic reimbursement systems are causing a dramatic increase in adoption of telehealth services by providers nationwide, but results of a recent survey suggest the industry is still transitioning to the new care delivery model.

Consumer adoption no longer appears to be a limiting factor in telehealth adoption, says the report, “Closing the Telehealth Gap,” sponsored by Avizia, a telehealth solution provider.

Rather, the main obstacle to telehealth adoption by healthcare providers remains centered around cash flow, particularly the lack of investment to fund adoption of telehealth, or enough potential revenue to justify an expense. The top two barriers, encountered by about half of organizations, are the necessary investments for telehealth technology and infrastructure (50 percent) and issues related to reim¬bursement (48 percent).

“Hospitals and doctors know where they need to go, and they ultimately know what is best for their patients, but costs and reimbursement challenges have inhibited their ability to move forward,” says Alan Pitt, MD, Chief Medical Officer at Avizia and attending physician and Professor of Neuroradiology at the Barrow Neurological Institute.

“Getting hospitals, physicians, health plans and telehealth companies on the same page will be critical to moving healthcare forward and improving public health,” Pitt added. “We talk a lot about collaboration in healthcare between the payers and providers, but in order to truly deliver on the promise of value-based-care, it’s clear that technologists need to be a part of the business conversation.”

Overall, the report found 72 percent of U.S. hospitals are currently using telehealth, compared with 52 percent of physician groups and clinics.

Current trends in reimbursement reform, such as value-based care, accountable care and population health, are advancing the use of telehealth services, says Pitt.

“Fee for service payment drove telehealth sales via a model related to hospital referral,” he said. “Federal mandates, and MACRA specifically, requires execution on healthcare’s triple aim—lower cost, higher patient satisfaction, better outcomes. Many of the activities to actually perform this level of care will require providers to engage in more communication with their patients, the core value proposition of telehealth. Provider scoring within MACRA will be based on data starting in 2017 with clear implications for reimbursement beginning in 2019.

“Secondarily, the direct-to-consumer market, the ability to keep patients in your network/ACO have required many healthcare systems to create online opportunities for care,” he added. “There are a host of additional business models related to reducing readmission, reducing length of stay and improving secure messaging between providers that are all being explored throughout the US.”

The most popular use of telehealth is through a computer workstation on wheels or “tablet on a stick” with 40 percent of responding organizations reporting usage. The future, on the other hand, looks entirely different, with executives most wanting their organiza¬tions to implement video visits through the electronic medical records system (EMRs), and adopting mobile apps for provider-to-provider and patient-to-provider communications.

Healthcare organizations will need to improve technical capabilities to take full advantage of telehealth, Pitt believes. “Ironically, hospital bandwidth remains one of the biggest challenges to successful deployment of telehealth,” he said. “Hospitals are often older buildings not built for wireless infrastructure.”

The ability to seamlessly exchange information between systems is another barrier to telehealth adoption, says Mike Baird, Avizia CEO and co-founder.” Improved interoperability in EHR technology is necessary to enable easier transfer of data records between sites to enable seamless workflow and easier doctor acceptance,” he explained.

Other findings in the report include:

  • Healthcare providers in large states (population 8 million to 14.9 million) are the least likely among all state groups to use telehealth.
  • Small states are the most likely to encounter regulatory issues.
  • Physician practices and clinics have more trouble with maintenance and ongoing support for the technology than hospitals and health systems.

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