Health Affairs lays out telehealth debate in new briefing, shows concerns over quality and reimbursement

By Intel Free Press [CC BY-SA 2.0 (http://creativecommons.org/licenses/by-sa/2.0)], via Wikimedia Commons

While telehealth is gaining ground as a way for healthcare providers to save money, concerns over the quality of care received still need to be ironed out, according to a new briefing from Health Affairs.

Telehealth supporters say the process, where a doctor consults a patient using tools such as video chats and mobile monitoring devices, can help lower hospital readmissions tied to chronic conditions. Proponents also point to a decrease in the unnecessary use of emergency appointments, brought about through remote visits with nurses.

On the other hand, opponents argue that telehealth services are not equivalent to in-person services and should not receive reimbursements that rival those of face-to-face visits.

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Patients are supporting telehealth in greater numbers in recent years, according to the brief. Many are looking to mobile applications, online services and health tracking devices to continuously monitor blood pressure and heart rate. Increasingly, consumers are enticed by telehealth's promise of better access to care, as well as greater efficiency and decreased stress and time constraints.

But new technology should be approached with caution, the brief outlines, as it sometimes proves unreliable and might lead to improper diagnosis and treatment, an opinion echoed by the American Optometric Association, which called online care models "substandard". The AOA also has said that telehealth may actually create greater inequity in the quality of care available in rural areas.

Also, since many telehealth appointments may be one-time engagements, that could create gaps in records that may affect future diagnoses and treatments.

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Of course, the reliance on Web-based technology means patient privacy is another area of concern. Though many believe that the risks associated with telehealth are no greater than those posed by the move toward digital records in general.

Whether telehealth should be reimbursed the same amount as in-person care is also up for debate, the briefing claimed. If telehealth services save money and are more efficient, opponents argue, reimbursement for services should mirror those savings. Add to that the high risks and potential for lower-quality care, and many physicians are convinced that telehealth should not be reimbursed on the same level.

In response, many point to the need to develop and support telehealth services to improve the quality of care provided and to create incentives for patients and doctors to use telehealth. By reimbursing at the same rates as in-person services, states support the growth and development of telehealth, while encouraging more and more physicians to use it as a method of care, Health Affairs said.

But if reimbursements for telehealth do not align with in-person services, the cost savings projected for telehealth will never be realized because providers will stay with in-person services to recoup their costs, according to the brief.

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The Medicare Telehealth Parity Act, currently being considered by Congress, is intended to modernize the way Medicare reimburses telehealth services and to expand coverage for Medicare beneficiaries, the brief said. The act would expand the number of qualifying geographic locations and expand coverage of telehealth services, although its likelihood of enactment is unclear.

To reap the benefits of telehealth services, states are likely to move toward full parity laws for telehealth services, according to Health Affairs. Without parity, there are limited incentives for the development of telehealth or for providers to move toward telehealth services. If there are no incentives to use telehealth, the brief projects that providers will continue to focus on in-person care, which will keep healthcare costs high, continue to create access issues and possibly provide lesser standards of care for chronic disease patients who benefit from remote monitoring.

Twitter: @JELagasse