How providers in South Carolina and Texas are overcoming telehealth obstacles

David McSwain, Julie Hall-Barrow, will speak at HIMSS19.

The use of telehealth is growing as the Centers for Medicare and Medicaid Services continues to expand reimbursement for its use.

But there are still some under-recognized challenges to telehealth adoption, according to Dr. David McSwain, chief medical information officer of the Medical University of South Carolina.

McSwain and Dr. Julie Hall-Barrow, senior vice president of Network Development and Innovation at Children's Health in Dallas, Texas, both have extensive experience in the clinical, academic, administrative, financial, technical and payer settings. 

Consumers are already onboard to the convenience of telehealth and many large healthcare systems and payers have invested millions in the space, McSwain said.

The greater challenges lie in getting buy-in from healthcare providers. Many remain skeptical or even opposed to the growth of telehealth, and some large professional societies have publicly expressed concern over its widespread adoption due to the risk of fragmented care and a lack of adequate data demonstrating effectiveness, McSwain said. Many payers are restricting payment for services due to concerns about over-utilization without evidence of decreased costs.

The two main challenges to breaking down these barriers are in proving the value of telehealth and promoting practice change. Telehealth advocates often promote theoretical future benefits that have yet to be demonstrated through rigorous evaluation of processes and outcomes, McSwain said. 

The benefits are held up by inefficient, ineffective, or inconsistent workflows, poorly implemented technology, disinterested providers, political or competitive factors and a lack of reliable outcomes data. Organizational inertia, opportunity costs, liability concerns, and a general lack of reliable information on telehealth implementation can also get in the way, he said.

Hall-Barrow found that getting there requires much work and more than a little push.

About five years ago, Children's Health wanted to look at telemedicine as a strategy to keep patients healthy, and for overall population health.

"If we can get kids diagnosed quicker, the long-term outcome has a much better chance," Hall-Barrow said.

In a school-based telemedicine program, the school nurse could deliver low acuity care through connection to a provider, but that primary care physician had to be the PCP of record for the patient.

"We worked hard with the government." she said, "Now, any provider can bill a school-based program and Medicare will pay for it."

Another hospital program connects a specialist to a provider. In pediatric emergency medicine, a telehealth ER program allows 60 percent of patients to get care from their local provider, reducing transportation costs and allowing more parents and children to stay together at home.

Hall-Barrow is still fighting to get the home deemed a billable site for Medicaid.

Telehealth is being used in the children's hospital for remote patient monitoring programs, such as digital sensors that measure medication compliance.

"We set the stage knowing it's covered," Hall-Barrow said. "I think anytime we reduce barriers for how to deliver care, it's a win for everybody. It offers the ability for us to provide high quality care at any delivery point."

For older Americans, this past October, the Centers for Medicare and Medicaid Services came out with a new rule expanding the ways providers can use telehealth and get paid by Medicare Advantage plans.

Once the rule goes into effect in 2020, providers will be able to keep track of a patient's health through remote monitoring and consumers will be able to connect to their physicians through telehealth from their homes.

CMS is also being more flexible in reimbursing for traditional Medicare telehealth services, allowing for more codes for telehealth in the home, for a broader range of conditions.

Previously, consumers had to be in a provider's office or another designated place, or live in a rural area, to use telehealth, at least from the standpoint of reimbursement.

All of these changes can cut down on the amount of ER visits and improve the management of patients with complex conditions, McSwain said.

McSwain, who chairs the American Academy of Pediatrics Section on Telehealth Care, said CMS's new flexibilities "sent a serious wave of excitement around the country."

McSwain and Hall-Barrow will discuss this during a HIMSS19 session titled "The real challenges of telehealth adoption," scheduled for Tuesday, Feb. 12, 10:30-11:30 a.m., in room W307A.

Twitter: @SusanJMorse
Email the writer: susan.morse@himssmedia.com