32 things to know about telemedicine

One of the biggest trends to emerge from healthcare's digital revolution is telemedicine.

Here are 32 things to know about the growing role telemedicine is playing in the healthcare industry.

Defining telemedicine

1. Telemedicine is two-way, real-time interactive communication between a patient and healthcare provider at a distant site. The communication is supported by, at minimum, audio and video equipment. Telemedicine has been cited as being particularly helpful in rural areas, where access to healthcare and healthcare specialists can be difficult.

2. Originating sites for Medicare telemedicine services in CY 2015, as defined by HHS include:

•    Physician or practitioner offices
•    Hospitals
•    Critical access hospitals
•    Rural health clinics
•    Federally qualified health centers
•    Hospital-based or critical access-based renal dialysis centers
•    Skilled nursing facilities
•    Community mental health centers

3. Distant site practitioners under Medicare include:

•    Physicians
•    Nurse practitioners
•    Physician assistants
•    Nurse-midwives
•    Clinical nurse specialists
•    Certified registered nurse anesthetists
•    Clinical psychologists and clinical social workers (These providers cannot bill for psychiatric diagnostic interview examinations with medical services or medical evaluation services under Medicare).
•    Registered dieticians or nutrition professionals
Practitioners allowed to provide telemedicine services are subject to state law.


4. Telemedicine parity laws, adopted on a state-by-state basis, require payers to cover telemedicine services at the same rate as if they were delivered in person. At this point, 28 states and Washington, D.C., have telemedicine parity bills, according to the American Telemedicine Association. The following 13 states do not have parity laws:

•    Alabama
•    Alaska
•    Florida
•    Idaho
•    Kansas
•    Nebraska
•    North Dakota
•    South Carolina
•    South Dakota
•    Utah
•    West Virginia
•    Wisconsin
•    Wyoming

5. Several states have proposed parity legislation, including:

•    Illinois
•    Iowa
•    Massachusetts
•    New Jersey
•    North Carolina
•    Ohio
•    Pennsylvania
•    Rhode Island

6. The majority of states have telemedicine coverage, but that coverage differs. The American Telemedicine Association analyzed each state's individual policies and rated the best and worst states for coverage and reimbursement in its January 2016 State Telemedicine Gaps Analysis report. The majority of states received a B grade, while a few stood out with 'A' grades or 'F' grades.

The following states received A grades:

•    Delaware
•    Maine
•    Mississippi
•    New Mexico
•    Nevada
•    Oklahoma
•    Tennessee
•    Virginia
•    Washington, D.C.

The following states received F grades:

•    Connecticut
•    Rhode Island

7.  In 2014, Medicare reimbursement for telemedicine services was $13.9 million, according to CMS data provided to the Robert J. Waters Center for Telehealth and eHealth Law. Approximately $12.48 million of that amount went to provider fees (location of the telemedicine provider) and $1.45 million to originating site fees (location of the patient).

8. Though Medicare is prepared to reimburse for telemedicine services, the amount actually spent on these services is low. In 2012, Medicare spent $5 million toward telemedicine, just 65.2 percent of the allotted $7.7 million set aside for telemedicine charges. This breaks down to just $0.09 per Medicare enrollee per year spent on telemedicine, according to a Telemedicine journal and e-health study.

9. In 2016, Medicare offers coverage for more than 30 telemedicine services. Click here to see the full list of CPT and HCPCS codes.

10. The Creating Opportunities Now for Necessary and Effective Care Technologies, or the CONNECT for Health Act, has been introduced in the Senate. The legislation seeks to promote the access to and use of telemedicine by waiving Medicare's restrictions on when it will cover services delivered remotely.

11. Commercial payers are increasingly offering telemedicine coverage. In March, Independence Blue Cross in Philadelphia announced two options for telemedicine consultations. Members can receive telemedicine consultations through their primary care providers, or they can access telemedicine services through the payer's partnership with telemedicine vendor MDLIVE.

12. Telemedicine already has a significant toehold in the healthcare market, and that footprint is only expected to grow. In 2014, the market was valued at $14 billion, according to a report from Zion Research.

13. The global telemedicine market is expected to hit a $35 billion value by 2020, according to the Zion Research report.

14. The driving factors behind telemedicine's rapid growth include the aging population, the rise of smartphone use and the prevalence of chronic disease.

15. In 2014, there were approximately 19.7 million telemedicine video consultations, according to a Tractica report. The number is expected to grow to 158.4 million by 2020, a 700 percent increase.

16. Telemedicine may be catching on, but many consumers remain unaware of or unfamiliar with this option. Approximately 66 percent of consumers are unfamiliar with the service but would be willing to try it, according to a :DentalPlans survey.

17. The :DentalPlans survey identified six primary reasons consumers would be interested in telemedicine. The survey respondents were able to select more than one answer.

•    Medical care without traveling to a healthcare facility: 53.9 percent
•    Easy, around-the-clock-access to medical help: 50.5 percent
•    No need to go to a physician's office for minor, reoccurring ailments: 38.3 percent
•    No need to pay for a visit to a physician, emergency department or urgent care clinic: 35.5 percent
•    No concerns about exposure to other patients' illnesses: 21.1 percent
•    Ability to receive medical care when taking time off work is not possible: 17.2 percent

Key players

18. Large health IT companies have stepped into the telemedicine market. Key players, according to a Research and Markets report, include:
•    Cerner
•    GE Healthcare
•    Honeywell Life Care Solutions
•    IBM
•    McKesson
•    Philips Healthcare

19. Providers that have made a name for themselves in the urgent care market, such as CVS and Walgreens, are throwing their hat in the telemedicine ring, as well. In 2014, CVS' MinuteClinic tested telemedicine services at 28 locations, according to a Drug Store News report.

20. In 2015, Walgreens Boots Alliance announced the expansion of its telemedicine services. In December 2014, Walgreens launched a pilot program with telemedicine provider MDLIVE. Now, Walgreens' telemedicine services are being rolled out in 25 states by the end of the year.

21. American Well was founded in 2006. The company provides telemedicine for hospitals, health systems, health plans, employers and physicians. This year, American Well released its Telehealth Software Development Kit, which allows developers to add online visits to their native apps.
22.  MDLIVE was founded in 2009. The company uses its cloud-based Virtual Medical Office software platform to connect healthcare providers with patients. The HIPAA-compliant system offers consultations on a nationwide basis. MDLIVE recently forged a new partnership with Englewood, Colo.-based Centura Health. Through the program, consumers in Colorado and western Kansas have access to board-certified physicians 24 hours a day, 365 days a year through secure online or mobile app video visits. The visits cost $49 each.

23. Teladoc is another major player in the field. It was the first telemedicine provider, founded in 2002. Now the company facilitates thousands of consultations each day. The company hit a new benchmark in March with 3,000 e-visits in a single day.

24. HealthTap is another telemedicine company. In March, the digital network announced it now has more than 100,000 participating licensed physicians.

25. Competing telemedicine companies have not always inhabited the same market in harmony. Teladoc and American Well are embroiled in a patent infringement lawsuit. American Well filed the lawsuit alleging Teladoc "unfairly disregarded" American Well's intellectual property.

26. There are several startups also breaking into the telemedicine market. On a CB Insights list of 42 mobile startups impacting healthcare, several telemedicine companies made the cut, including:

•    American Well
•    Better
•    Doctor on demand
•    HealthTap
•    Maven Clinic
•    MDLive
•    PingMD
•    Sherpaa Health
•    Spruce Health
•    Touchcare

27. The American Telemedicine Association launched its Accreditation for Online Patient Consultations this year. Shortly after launching, the program received 200 applications for accreditation. American Well's Amwell service was the first to be accredited.

28. Last year, the accreditation program awarded CareSimple and MDLIVE online patient consultation accreditation. There are now approximately 300 organizations registered for the ATA's Accreditation Program for Online Patient Consultations.

Physician insight

29. Consumers are not the only ones with a growing interest in telemedicine. Physicians are increasingly considering this virtual outlet a viable and useful care option. The top 10 specialty video consults primary care physicians find most useful, according to an American Well survey, include:

•    Dermatology: 76 percent
•    Psychiatry: 54 percent
•    Infectious disease: 46 percent
•    Pain management: 37 percent
•    Neurology; 36 percent
•    Cardiology: 34 percent
•    Rheumatology: 32 percent
•    Gastroenterology: 24 percent
•    Sports medicine: 18 percent
•    Oncology: 17 percent  

30. Physicians listed the top 10 uses for telemedicine in an American Well survey conducted in collaboration with QuantiaMD.

•    Concierge services for fee-paying patients: 91 percent
•    Medication management/prescription renewal: 86 percent
•    Minor urgent care: 85 percent
•    Birth control counseling: 83 percent
•    Home healthcare: 82 percent
•    Chronic condition management: 80 percent
•    Pediatric after-hour needs: 79 percent
•    Behavioral health: 77 percent
•    Post-hospital discharge: 73 percent
•    Post-surgical follow-up: 59 percent

Outcomes vs. objectives

31. The top three telemedicine program priorities, according to a survey from telemedicine provider REACH, include:

•    Improving patient outcomes: 96 percent
•    Patient convenience: 87 percent
•    Patient engagement and satisfaction: 86 percent

32. When asked about success in achieving these goals, respondents reported:

•    Improving patient outcomes: 55 percent
•    Improving patient convenience: 62 percent
•    Increasing patient engagement and satisfaction: 44 percent

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