The convergence of medical advances, health information technology, and a nation-wide broadband network will transform the delivery of care by bringing the health care provider and patient together virtually.
This is important, as more than 50 million Americans lack access to primary care services due to doctor and provider shortages at local practices, community health centers, and hospitals. In many rural communities, patients must travel long distances to health care providers to receive treatment. Telehealth will connect the patient and provider virtually at the point and time of care, and has tremendous potential to improve patient care and to lower health care costs.
Telehealth leverages technology to bring the doctor to the patient. Mainstream telehealth services include remote monitoring, tele-consults and remote diagnosis, evaluation and management. A number of studies have documented the clinical and cost saving benefits of telehealth:
- Remote monitoring pegged savings for those with congestive heart failure, diabetes and COPD at $21.1 billion annually;
- Reduced use of expensive care settings, such emergency rooms and inpatient hospital. One study showed 58 percent fewer hospital admissions for those with heart and lung disease or chronic wounds than a control group; and,
- In another study, video visits cut hospital expenses by 44 percent.
In addition, telemedicine can help:
- Increase access to care and relief for provider shortages;
- Improve patient outcomes and quality;
- Decrease disparities and variations in care; and, Expand patient preferences for site of care delivery, such as convenience, satisfaction, and family involvement.
Congress required the Department of Defense to expand telemedicine opportunities to service members regardless of whether they are on a base or in a home, and regardless of the provider’s state licensure. The VA has moved to mostly eliminate cost sharing on telemedicine, recognizing treating veterans at home is less expensive than treating them in a VA facility. For example:
- VA’s home telehealth has resulted in a 30 percent reduction in hospital admissions and a 20 percent decrease in hospital stays; and,
- The average annual cost per patient of VA’s home telehealth program adds up to $1,600, a substantial savings over the $13,000 for direct home care or $77,000 for nursing home care.
Barriers to Telemedicine in Medicare and Private Market Persist
There are current and emerging technologies that include remote patient monitoring, real-time video consultations, remote diagnostics, mobile applications, and robotic applications. But these applications are hampered by barriers to the use of telemedicine, including:
- Medical licensure laws that tie providers to state boundaries rather than empowering patients and providers to engage in care electronically;
- Outdated Medicare structure that limits telemedicine largely to rural areas;
- Limited Medicare reimbursement for care delivered electronically (less than 0.1% of Medicare spent on telemedicine); and,
- Lack of interoperable health IT systems that enable new care models, such as ACOs, medical homes, and episodic care.
Congress should remove barriers, such as interstate licensure requirements, in all federal programs, including Medicare, Medicaid, and FEHB. Doing so will help realize the benefits of a nation-wide health network to improve population health, create jobs, and stimulate innovation.
As the population becomes more mobile, people demand and expect access to lower cost care from anywhere – whether it is from a home in a rural area, an apartment in the city, or on the go.
- Allow Medicare enrolled providers to perform medical services remotely through telemedicine regardless of where the patient is geographically;
- Medicare beneficiaries, like the Department of Defense service members, would access care from their doctors or specialists so long as they are Medicare enrolled;
- Implement interoperable technologies that can openly exchange patient information across systems, modules, applications, devices, and emerging technologies;
- Provide reasonable reimbursement for telehealth services in Federal health programs;
- Implement the health care recommendations of the 2010 National Broadband Plan of the FCC that will encourage the development of a open, standards-based, nationwide health care architecture to connect and expand access to health care anywhere and anytime; and,
- Establish a regulatory process that encourages innovation and speed to market.