As the Affordable Care Act expands insurance coverage to more and more people, telehealth can make it possible for the newly insured to access care in a timely manner. Meanwhile, the promise of telehealth in new care models under the ACA is accelerating growth in the sector.
Licensure and reimbursement issues could stop these advancements in their tracks, but lawmakers and industry groups are taking steps to address potential roadblocks.
ACA Spurring Telehealth Implementation
A recent report by consulting firm RNCOS predicts that the adoption and use of telehealth technology globally will “continue at a rapid pace.” In fact, the firm expects the telehealth sector to grow at a compound annual growth rate of 18.4% from 2014 to 2020. In the U.S., venture funding for telehealth grew 315% just last year — the fastest-growing sector in the digital health industry.
Netspective CEO Shahid Shah said in an interview with Hands on Telehealth that the ACA will “directly affect telehealth,” as providers move toward value-based, shared savings and accountable care models. Shah said, “A doctor who communicates with her patients more can influence the patients better and give them better guidance. … There appears to be no better way than telehealth to improve communications with patients.”
Kathy Chorba, executive director of the California Telehealth Resource Center, agrees. Chorba tells California Healthline, “As we move toward accountable care, we will see accelerated telehealth adoption, as the ACA is looking towards using funds and resources more efficiently and at value-based models, which makes telehealth an attractive option for both providers and payers.” She adds, “Telehealth, when used for care coordination and management, will play a significant role in making ACOs run with greater efficiency.”
In addition, the ACA’s Medicaid expansion could speed up telehealth adoption and increase residents’ access to virtual health care services. Medicaid programs in 47 states now offer some level of coverage for certain telehealth services.
How Telehealth Is Advancing the ACA’s Goals
Meanwhile, as more U.S. residents gain insurance coverage under the ACA, some are finding it hard to access health care services. The Association of American Medical Colleges has said that the U.S. will experience a growing physician shortage over the next decade, even after taking potential staffing changes into consideration. A recent AAMC report predicts that ACA implementation will increase demand for physicians by 2%, over and above the increased demand resulting from changing national demographics, such as a growing aging population.
Adam Jackson, CEO of Doctor on Demand, told Wired that telehealth can help address a shortage of primary care physicians. For example, telehealth could be used to treat patients with less-serious illnesses, increasing access to care for patients who are sicker, Jackson noted. “These visits keep the colds and flus and allergies and bumps and bruises out of the offline settings. That frees up the waiting rooms, so doctors can treat more pressing issues,” he said.
Chorba tells California Healthline that telehealth also can help improve access to specialty care — particularly mental health services, which are tied to primary care under the ACA. Chorba says mental health services “can efficiently and economically be delivered via telehealth,” adding, “Utilizing telehealth technologies to access specialty care will help primary care providers to obtain the right care at the right time for the patient, which will theoretically decrease the number of times that patient returns to the office for the same diagnosis.”
Righttime Medical Care is one provider that has turned to telehealth to help improve patients’ access to medical care. Righttime recently adopted telehealth capabilities through HealthGrid — a move that CEO Robert Graw says helps the company cater to newly insured customers. Graw said, “[Telehealth is] really access to care,” adding, “The Affordable Care Act is meant to provide access to folks and lower the costs of medical delivery. … There are many conditions that [patients] could resolve through a telepresence visit.”
Barriers Quickly Disappearing
While the ACA is boosting telehealth implementation, and telehealth in turn is helping to accomplish some of the law’s goals, some barriers to optimal telehealth use remain.
Licensure
An obstacle facing doctors who want to practice telemedicine is differing state licensure rules.
A recent American Hospital Association report notes, “Because current state licensure laws may not reflect the changing nature of medical practice and the growing use of technology, existing licensure laws could unintentionally present barriers to the opportunities and innovations of telehealth.”
But lawmakers and industry groups are taking steps to address the issue.
Just last month, the Federation of State Medical Board’s interstate compact for physician licensure reached the seven-member threshold needed to start implementing the compact. The compact aims to facilitate the licensing of doctors across state borders to expand telehealth. It will not have the authority to license physicians but could facilitate all of the necessary information to streamline the process.
Federal lawmakers also are aiming to ease licensure rules. For instance, lawmakers are considering removing the requirement that Department of Veterans Affairs patients and providers be in a federal facility for telehealth services to be provided across state lines.
Insurance Coverage
A lack of insurance coverage for telehealth services also can hold back adoption.
“Current policy for reimbursement continues to threaten he expansion of telehealth,” Chorba said. For instance, Medicare does not compensate providers for telehealth services unless that care originates outside of a Metropolitan Statistical Area or within a rural Health Professional Shortage area.
However, Medicare this year began allowing providers to bill for non-face-to-face care management and care coordination for patients who have at least two chronic conditions. Jennifer Gingrass, a principal with ECG Management Consultants, said, “In essence, Medicare is moving in this direction [of covering telehealth], although a little indirectly.” As Medicare and state Medicaid programs increasingly cover telehealth services, observers say private insurers could follow suit.
In fact, Malay Gandhi, managing director at Rock Health, has predicted that more plans sold through the ACA’s exchanges will cover telehealth services in the near future. He said, “The network will be narrow and aligned to specific telemedicine providers, but it will be there.” That could help advance telehealth adoption.
“It will be interesting to see what happens when consumers who have grown to favor certain consumer telemedicine services are denied access to those providers by their insurance [plans],” he said.
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