Telemedicine gives patients and doctors a new way to connect. How is it impacting the healthcare industry?
- 77.5% of medical practices surveyed do not offer telemedicine services yet.
- 64% of medical practices surveyed plan on implementing telemedicine software soon.
- 9% of respondents want telemedicine software that integrates with their current EMR system.
In a healthcare industry where nearly 3 out of every 4 in-office visits to primary care physicians, urgent care clinics or the emergency room could be handled remotely via phone or video, telemedicine offers a chance to revolutionize the field. The concept of telemedicine isn't exactly new, but it seems to only now be reaching a critical mass, building toward the tipping point at which mass adoption takes hold. Regulatory challenges, payer policies and patient acceptance of telehealth are beginning to converge in a way that sets the stage for a remote healthcare future.
We analyzed survey data from business.com readers in the healthcare industry to identify trends related to small medical practices and the adoption of telemedicine from June 2015 to August 2019. What we found is telling about which practices are adopting telemedicine technology at the highest rates and what their needs are. The overwhelming majority of practices most interested in adopting this technology are mental health practices.
What is telemedicine?
Telemedicine refers to technologies that bring patients and healthcare providers closer together in a digital environment. Gone are the days of going to the doctor for a simple cold or minor rash – or at least that's the promise of telemedicine. With telemedicine, patients could have low-grade conditions assessed by their doctor via smartphone or desktop computer, rather than setting an appointment for something that can be addressed easily with over-the-counter medication.
"Telemedicine is the use of technology to close the physical gap between practitioners and patients," said Joel Wishkovsky, CEO of Simple Health. "It allows practitioners to remotely evaluate, diagnose and treat patients while at the same time offering patients a method to more conveniently and affordably access healthcare."
Also known as telehealth services, telemedicine technology aims to improve the physician-patient relationship by streamlining the way healthcare providers see their patients. It can be used for a diverse range of appointment types, including remote consultations and follow-up care. Telemedicine devices, like remote stethoscopes, offer providers the ability to make online encounters detailed and meaningful visits. Our survey data of business.com readers shows that many medical practices still do not offer telemedicine services but are adopting the necessary software and hardware to offer them at a steady rate. Most of the respondents to our survey said they intend to add telemedicine to their list of services within one to two months of filling out the questionnaire.
Telehealth is useful for primary care physicians and specialists alike. Dermatologists, for example, could examine a patient's skin remotely and determine whether an in-office visit is truly necessary. Mental health specialists could offer remote sessions to their patients.
In the U.S., more than 46% of adults experience a mental illness during their lifetime. However, only 41% of all adults who experience a mental health disorder ever receive professional care. Telemedicine could lower barriers to mental health services for these patients and improve access in communities where mental health disorders remain stigmatized.
"Telemedicine improves patient access; it increases time efficiencies by reducing travel to visits, allowing patients to complete visits in the comfort of their home or office; it reduces the overall cost of care, and improves quality and patient experience," said Jagdeep Bijwadia, chief medical officer at Beddr. "Specialty care only available in tertiary care hospitals can now be offered nationwide, including in rural areas, expanding access to high-quality care."
Telemedicine technology has been increasingly adopted by health professionals throughout the last decade, even making its way into many leading electronic medical records (EMR) systems. How widespread is the adoption of telemedicine technology? And how quickly can we expect to see more medical practices ramp up their own telehealth services?
How widespread is telemedicine adoption today?
Telemedicine has become a growing pillar of the healthcare industry. According to Chiron Health, there are about 200 active telehealth networks in the U.S. today, which manage more than 3,500 service sites. Further, more than half of all hospitals in the U.S. now offer some form of telehealth services. The growth of the telehealth sector of the healthcare industry is so rapid, it is expected to reach $93.45 billion in value by 2026, up from $21.56 billion in 2017.
Small medical practices and telemedicine adoption
How precisely do small medical practices stack up when it comes to telemedicine? We reviewed survey data captured from business.com across four years of telemedicine adoption. It shows that interest in telemedicine hasn't waned, and intended adoption rates remain steady among small medical practices across the spectrum of specialties. To infer more about the state of telemedicine and emerging trends in the industry, we reviewed this data, which ranges from June 2015 to August 2019 and includes responses primarily from medical practices with one to three providers. Here's what we found:
- 77.5% of medical practices surveyed did not yet offer telemedicine services.
- 64% of medical practices surveyed planned on implementing telemedicine software "ASAP" or "within one month" of responding to the survey.
- Mental health specialists were by far the most interested in telemedicine software, with 2,304 respondents; the next largest specialty in the survey was family medicine, with 1,832 respondents.
- Respondents were split just about evenly on whether they wanted a stand-alone telemedicine solution (47.1%) or one that integrates with their current EMR system (52.9%).
Telemedicine is a growing trend that more medical practices add to their services every year. As more patients are exposed to telehealth, these services become normalized, driving demand and further adoption. However, despite the progress, significant regulatory hurdles and barriers to entry remain.
If you are interested in offering telemedicine at your medical practice, but aren't sure where to begin, we want to hear from you. Fill out the survey below to help improve our data, and receive more information about telemedicine software and services from our vendor partners.
Challenges related to telemedicine adoption
Telemedicine has been around for more than a decade, yet it remains relatively new from a policy standpoint. Reimbursement regulations are fragmented on a state-by-state basis. And, of course, medical practices must abide by the usual key regulations in the industry, such as the Health Insurance Portability and Accountability Act (HIPAA). Moreover, nonregulatory challenges abound, from patient technological literacy to the cost of telemedicine technology.
Telemedicine and healthcare industry regulations
The healthcare industry is no stranger to regulations. Hospitals and medical practices capture a considerable amount of sensitive patient data, the security and management of which is governed by federal laws like HIPAA. Healthcare IT products are also heavily regulated, subject to federal laws like the Health Information Technology for Economic and Clinical Health (HITECH) Act. Telehealth is no different, subject not only to the federal laws that have become familiar to health professionals, but also a series of diverse state laws and regulations associated with the delivery of remote care.
"The primary considerations are associated with practitioner licensing, privacy, and security of patient data and clinical practice requirements," said Wishkovsky. "On the licensing side, practitioners typically must hold a license in the state in which the patient is accessing the telehealth service. On the privacy and security side, this means compliance with federal laws like HIPAA and a slew of state laws and regulations."
According to Wishkovsky, many states have imposed specific regulations governing how medical practices employ telehealth during a patient encounter. These rules vary across states, contributing to the fragmented nature of telemedicine's current regulatory environment.
"While full discretion over how to deliver care is typically left to a physician's best judgment in an in-person setting, many states have imposed arbitrary requirements on those same providers who choose to practice online," Wishkovsky said.
Regulating telemedicine reimbursements
How insurance companies and public payers reimburse healthcare providers for telemedicine services is not always clear. Indeed, it has been a point of contention. States continue to release their own versions of telemedicine reimbursement regulation, often referred to as parity laws. However, the national landscape remains significantly fragmented, with regulatory vacuums in 14 states.
"Telehealth implementation varies widely from state to state in terms of how much service providers will be reimbursed for delivering telehealth services, as well as what sort of parity is expected between in-person health services reimbursements versus telehealth reimbursements," said Bijwadia.
Parity refers to whether payers, such as insurance companies, treat telehealth in an equivalent manner as they do in-person medical services. Historically, that has not always been the case, meaning healthcare providers did not receive their fair share for delivering services via telemedicine. However, state regulation has started to change that.
Today, 36 states and Washington D.C. have established parity laws, which set rules for how payers provide reimbursement for telehealth services. While parity laws are a step toward standardizing payment to healthcare providers for the provision of telehealth services, payer obligations vary significantly from state to state.
"In some states, laws have been passed to mandate either partial insurance coverage for eligible telemedicine services or full parity in reimbursement when the same service is delivered online," said Wishkovsky. "However, in some states, coverage is poor or nonexistent. Another complicating factor is that [telemedicine visits] … don't always structurally align with billing codes used for in-person care. In these instances, without a billing code, reimbursement may be flat-out impossible."
The upfront cost of telemedicine technology
Another barrier to starting a telemedicine program is, of course, cost. Telemedicine technology is not always cost-effective, making it difficult for medical practices on a budget to swing the required overhead investment. Moreover, if you are in a state where parity laws do not yet exist or do not favorably look upon telehealth services, that investment could generate very little return in the near term.
"The technology can be expensive in some cases," said Bijwadia, adding that "reimbursement for home-based telemedicine is still not widely available."
To launch a basic telemedicine program, a medical practice needs telemedicine software, certain medical devices, a video conferencing platform, hardware and training. The costs for each of these components can vary significantly and quickly add up. Software alone can cost anywhere from $20 per user, per month to $500 per user, per month. Hardware and medical devices could represent tens of thousands of dollars in expenses, while training could run a few thousand more. All told, a medical practice could easily spend more than $50,000 to launch a telemedicine program, and that's a conservative estimate.
Patient acceptance of telemedicine services
Telemedicine remains new to many patients, so it is unclear how quickly they will accept it. Healthcare is a business like any other, and the adoption of new services and technologies is driven by consumer demand. In some markets, patients might clamor for telehealth, while in others, the demand might be abysmal. It does seem, however, that patients are interested in telemedicine and willing to try it out. That's a good sign for medical practices that have adopted telehealth as part of their services.
"While telemedicine is living up to its potential and providing value – with providers increasingly investing in and advocating for it – perhaps one of the biggest hurdles is changing the status quo when it comes to patients' expectations," Wishkovsky said. "We've learned that the concept of telemedicine is still so new for most patients that it's important to instill confidence and build trust with patients before they'll adopt this new method. As an industry, we need to continue to make strides in helping the average person feel more comfortable with and accepting of remote care."
A survey conducted by American Well found that 1 in 5 patients is willing to switch their primary care physician to one that offers telemedicine. The biggest motivators for these patients is the potential for cost savings and convenience. Telemedicine offers a particular appeal to patients with chronic visits, who make up roughly 76% of all physician visits.
Extending telemedicine services to these patients could reduce in-office appointments, saving both patients and providers time and money. Roughly 67% of patients aged 45 to 64 with a chronic condition expressed a willingness to try out a telehealth visit, suggesting that widespread normalization of telehealth services is just around the corner. Further, 74% of all patients say they would be open to scheduling a virtual health visit. These statistics bode well for medical practices that are investing in telemedicine technology.
The future of telemedicine is now
Telemedicine has long been an around-the-corner technology for the healthcare industry, offering lofty promises and a slow buildup. Now, however, it is becoming a frequently used tool that can save time, money and improve patient outcomes.
While the regulatory landscape remains unclear, patient demand for telehealth services is growing quickly. Offering telemedicine is becoming an industry standard for medical practices and hospitals alike. As parity laws begin to create a reimbursement equivalency between remote healthcare services and in-person appointments, telemedicine could become a profitable channel for many health professionals.