Virtual Care: Positives and Challenges

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By Paul Murphy

Virtual care continues to advance throughout healthcare. With this momentum positive benefits are being recognized. Similar to many industries, there are challenges. The following provides a summary of some of the positives and challenges associated with virtual care. 

Positives

Quality Care & Patient Engagement: Virtual care has been associated with improving the quality of care that is provided. One report indicates that patients experienced reductions in hospital admissions (38 %), reduction in hospital re-admissions (31%), and reduced length of hospital stay (63 %).1  Patient engagement can be enhanced as well. Examples include maintaining appointments, care schedules, increased engagement efforts to assist with obesity management, and tracking tobacco use. Virtual care options can also reassure patients that their providers are available and involved in their care. This in turn can make it easier for the patient to reach out to their provider(s) with questions, report early signs, and schedule appointments to follow-up. This type of proactive and quality care can potentially reduce complications and the need for additional care.2

Consumer / Patient Adoption: The adoption of virtual care continues to increase. Adoption rates vary by generation with 60 % of millennials favoring telemedicine versus in-person care. For individuals 65 years and older, more than 50 % report being open to using virtual care to manage a chronic condition.3 Depending on the generation that is asked, reasons to use virtual care include: the desire to have access to a healthcare provider on their mobile device “now”, convenience, potential cost savings, and not having a serious condition. 3  This is in contrast to scheduling an in-person appointment, traveling to the provider’s office, waiting to be seen, being seen by a provider for 10 minutes, then traveling to the next destination such as school, work, or home. More than 75 % of consumers emphasize easy access to care and treatment over the mode of care delivery (virtual versus in-person) and interactions. 4 

Follow-up Care: Virtual care can be beneficial in follow-up care. In situations where a patient may need to have multiple post-procedure follow-up visits, technology can be used to replace the time that is needed for travel logistics and wait times. If additional clinical information is needed, such as blood pressure and weight, the patient can be provided peripheral devices, such as a blood pressure cuff and weight scale, to perform the procedures outside the clinic or hospital setting. 5   

Rural Access: A hallmark benefit of virtual care is the ability to provide services in areas that otherwise might not otherwise have access to that level of care. Patients in rural areas can benefit from remaining in their local hospital (originating facility) while receiving virtual care. In cases where the patient may need to be transferred to a facility capable of providing advanced care (receiving facility), virtual care can allow the consulting provider to see the patient via real-time audio and video prior to the patient being transferred. 6   

Medication Compliance: There are several factors that influence medication compliance by patients. Virtual care, via “apps” and other devices, are being used by organizations in an effort to promote compliance. This is significant because it is reported that for patients with chronic conditions they are compliant with only half of their prescribed medications. 7,8  The use of technology to promote medication compliance has been successful with one organization reporting a compliance rate exceeding 90 %. 9   

Challenges

Reimbursement: Payer reimbursement for healthcare services provided virtually remains to be a challenge. Reimbursement can vary (1) by state, (2) by the nature of the service being provided, and (3) by each payer. Payer parity, or payment that is equal to the payment for in-person services, is still in progress.10 The good news is that there is forward momentum. 

Fraud/Abuse: The Office of Inspector General (OIG) reports that Medicare spending for telemedicine (virtual care) increased from $61,302 in 2001 to $17,601,996 in 2015. 11  In light of the increasing presence of virtual care and increasing payments, oversight by several stakeholders, such as the OIG, will likely continue indefinitely. Despite the oversight, fraud and abuse has occurred in virtual health. In one case telemedicine providers billed payers more than $2 million for services that were either not needed or were never actually provided. Another case involved multiple individuals and companies receiving more than $1 billion after billing for false telehealth sessions. 12 

State licensure: Providers who want to provide virtual health services in different states must have a license in each state, just as they do when providing in-person care. The licensure process can take time, from weeks to months, to complete. In an effort to support obtaining licenses in multiple states in an expedited manner, the Interstate Medical License Compact (IMLC) can be used. Unfortunately not all states recognize the compact.13

Concerns: Consumers and providers have expressed some concerns regarding virtual care. For consumers, concerns include the loss of the personal connection with their provider, issues with access, and quality concerns. Providers concerns include medical errors, loss of data, and issues with technology. 14

Geographic Restrictions: There are restrictions regarding where virtual care services can be provided. Examples include federally qualified health centers (FQHC), rural health clinics (RHC), and Indian Health Services. Recent efforts include attempts to reduce geographic restrictions. Efforts such as “Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act of 2019” or “CONNECT”, continue to strive for advancing virtual care to patients such as those covered by Medicare. Examples include providers experimenting with telemedicine in various payment models and incentive programs, reducing site-specific coverage restrictions, and allowing providers to use virtual care to provide care to underserved populations. 15  

Closing

As virtual care advances throughout healthcare, traction is being made on several fronts, including patient adoption and provider reimbursement. Ongoing successes and improved patient care will continue to occur, supporting virtual care’s goal of providing access to quality care in a cost-effective manner.

Paul Murphy has been involved in healthcare for more than 15 years, including clinical and leadership roles. He has written articles and textbook chapters on a variety of topics ranging from clinical to leadership to technology, including virtual care and telemedicine.

References

1.Doxy.me, LLC (2019) What are the advantages of telemedicine? https://doxy.me/advantages-of-telemedicine

2. eVisit® Telemedicine Solution (2019) 10 Pros and Cons of Telemedicine.

https://evisit.com/resources/10-pros-and-cons-of-telemedicine/

3. DigitalOptometrics (2019) Interesting Telemedicine Statistics  https://www.digitaloptometrics.com/interesting-telemedicine-statistics/

4. TeleQuality Communications (2018). Blog: Web Roundup: 10 Fascinating Infographics About Telemedicine and Health IT https://www.telequality.com/blog/2018/8/24/web-roundup-10-fascinating-infographics-about-telemedicine-and-health-it

5.Eastwood, B. (2018) HealthTech. How Telemedicine Helps Healthcare Organizations Improve Patient Engagement and Satisfaction https://healthtechmagazine.net/article/2018/06/how-telemedicine-helps-healthcare-organizations-improve-patient-engagement-and-satisfaction-perfcon

6.Combs, V. (2019) TechRepublic, Innovation: How telemedicine keeps patients in rural communities healthy. https://www.techrepublic.com/article/how-telemedicine-keeps-patients-in-rural-communities-healthy/

7. Wicklund, E. (2018)  Xtelligent Healthcare Media Telehealth News: Using Telehealth to Help Patients With Medication Adherence. https://mhealthintelligence.com/news/using-telehealth-to-help-patients-with-medication-adherence

8. Dalton, T. (2017). Pharmacy Times: The Top Medication Reminder Apps for Patients. https://www.pharmacytimes.com/contributor/christina-tarantola/2017/12/the-top-medication-reminder-apps-for-patients

9. Pennic, F. (2019). HIT Consultant Media. Philips, Spencer Health Launches In-Home Medication Adherence & Telehealth Platform in Europe. https://hitconsultant.net/2019/10/15/philips-spencer-health-launches-europe/#.XbYCI5pKhPY

10. Public Health Institute/Center for Connected Health Policy (2019) The Federally Designated National Telehealth Policy Resource Center. State Telehealth Laws and Reimbursement Policies at a glance.  https://www.cchpca.org/sites/default/files/2019-10/50%20STATE%20INFOGRAPH%20FALL%202019%20FINAL.pdf

11. Department of Health and Human Services, Office of Inspector General (2018) CMS Paid Practitioners For TeleHealth Services That Did Not Meet Medicare Requirements. 

https://oig.hhs.gov/oas/reports/region5/51600058.pdf

12. Xtelligent Healthcare Media (2019) Policy News: False Telemedicine Sessions at Center of Federal Fraud Crackdown. https://mhealthintelligence.com/news/false-telemedicine-sessions-at-center-of-federal-fraud-crackdown

13. Interstate Medical Licensure Compact (2019) https://imlcc.org/

14. TeleQuality Communications (2018). Blog: Web Roundup: 10 Fascinating Infographics About Telemedicine and Health IT https://www.telequality.com/blog/2018/8/24/web-roundup-10-fascinating-infographics-about-telemedicine-and-health-it

15. Xtelligent Healthcare Media (2019) Policy News: Congress to Once Again Tackle Medicare Restrictions on Telehealth. 

https://mhealthintelligence.com/news/congress-to-once-again-tackle-medicare-restrictions-on-telehealth?eid=CXTEL000000499346&elqCampaignId=12163&utm_source=nl&utm_medium=email&utm_campaign=newsletter&elqTrackId=26ada637e3d44b07ae51e087c790dca8&elq=a0f96c1c934045839eb9b0f7405aad81&elqaid=12756&elqat=1&elqCampaignId=12163

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