Can Telehealth Reduce Costs? December 5, 2. 01. Can Telehealth Reduce Costs? By Elizabeth S. Roop. For The Record. Vol. The delivery model generally receives high grades for access and quality, but healthcare organizations are examining how it shakes out in economic terms. An evolving reimbursement structure and a push to transform the nation. For many healthcare organizations, it is a way to cut costs while improving quality outcomes, increasing revenues, and reaching more patients. Adding to the interest in launching or expanding telehealth services is the availability of financial assistance to offset costs as well as emerging care models that reward improved care management and shift utilization away from higher- priced settings. Patient engagement, caregiver collaboration, and better management of transitions in care . Key drivers include the push to reduce both the number of hospital visits and lengths of stay, which has manifested in a trend toward managing care outside the traditional hospital environment. Clearly, expectations are high for a relatively young delivery model. For hospitals that take the time to design telehealth programs to meet the unique needs of their patient population, it can be an economically sound investment with wide- ranging impacts. Navigating the Cost Curve. Unlike telemedicine, which is typically hospital based and focused on diagnoses and treatment, telehealth is a much broader application of technology to care delivery. It includes telemedicine but also more consumer- facing activities designed to deliver care and drive behavioral changes to improve overall health. Diagnostic (eg, telemedicine) is the most familiar and best established. Biological includes applications such as home diagnostics, while behavioral involves tools such as social networking, activity monitoring, and health coaching.
The interest in telehealth has come about in large part because of the growing emphasis being placed on consumer- oriented healthcare, which . While telehealth may be the new kid on the care delivery block, a growing body of evidence already supports its economic case. Most recently, researchers at Stanford University evaluated the impact of the Health Buddy telehealth program on Medicare patients from two clinics in the Northwest. They identified spending reductions of approximately 7. Their findings also found mortality differences between the treatment and control groups, which suggest that the intervention may have brought about changes in health outcomes. Baker, Ph. D, a professor of health research and policy at Stanford. The first was the tight integration of information and care management. The second was the device itself, which was easy for the patients to use. You have to investigate where you can get the most advantage from telehealth and then use the right tools. There are numerous factors that must be carefully considered before deciding whether telehealth makes financial and clinical sense for a particular facility. Typically, regions with a high incidence of chronic conditions are prime telehealth candidates, as are areas with rural populations or where consumers have difficulties accessing care. Mobile Telehealth Funding. Medicare Telehealth Payment Eligibility; Rural Health Grants Eligibility. Home > Tools > Find Grants. Program Name: State: County: Grantee. These are the people we want to be much closer to and monitor and moderate care. The whole notion of patient compliance with the regimen of care they go through is a huge deal. If patients are out of compliance, there are repercussions that cost money and hurt patients significantly. While it can have a significant impact on chronic conditions and help open access to patients who may not otherwise seek care, telehealth may also be the answer to more specialized needs. For example, telestroke has been shown to be cost- effective for rural hospitals that don. Pediatric telehealth has saved the U. S. Department of Defense as much as $7. Finally, ICUs that implement telemedicine intervention that includes off- site electronic monitoring of processes and detection of nonadherence to best practices have been found to have lower hospital and ICU mortality, lower rates of preventable complications, and shorter lengths of stay. In addition to stroke and emergency medicine, the center utilizes telehealth to provide psychiatry, dermatology, and high- risk obstetric services. Telehealth is also used to treat and control chronic conditions ranging from diabetes and chronic lung diseases to postmyocardial infarction management. These services are particularly valuable given the remote and rural populations within the center. Traditional geographic boundaries fell away and we now provide services anywhere in the state. While the price tag has gotten smaller as technology has advanced, it still requires a significant commitment of financial, human, and technical resources. The costs to launch a program vary broadly. Rheuban, a pediatric cardiologist and past president of the American Telemedicine Association, notes that the final price is often dictated by the level of integration the program is expected to achieve. Those require a smaller investment but tend to limit the program. Others, such as ours, are totally integrated . Our university made that investment early in our program development. Leadership understood the value, which I believe represents a major component of an institution. Nevertheless, she says the majority of expenses will come from the devices and technologies required as well as for patient and clinician training, ongoing technical support, and replacement costs. Another cost center many tend to overlook when first exploring telehealth is the personnel necessary to process the data being transmitted from patient to provider. Where will it go and who will analyze it? How will that be managed? Will it go into a data warehouse or a clinical data repository? Will analytics be applied in real time? How will out- of- range values be handled? There are a lot of moving parts associated with remote patient monitoring strategies. Health Resources and Services Administration (HRSA) awarded Regional Telehealth Resource grants of approximately $1 million each to three new organizations, including UVA, to create public- private partnerships in the Northeast, mid- Atlantic, and Midwest regions to provide support and resources to organizations to advance telehealth collaborations. Several additional grants are available through the HRSA, particularly for rural hospitals. These include the Licensure Portability Grant Program, the Telehealth Network Grant Program, and the Telehealth Resource Center Grant Program, all of which are competitive grant programs. Other federal agencies fund telehealth programs as well. Thus, the focus must be on identifying the sponsoring organization. In some cases, they are reimbursed for services provided (see sidebar), which helps them diversify their practices. It also allows them to better manage overall care for improved outcomes, which will become increasingly important under new models such as accountable care organizations and patient- centered medical homes. They get a lump sum for patient care. If they do well, they keep the money. While it was launched with the support of federal and state grants, sustainability was always the final objective. As such, it has tracked performance metrics from the outset to demonstrate the value telehealth brings to the state. We had to answer to the clinicians providing the services over telehealth and to the patients themselves. In 2. 01. 0, telehealth saved 1. Other key metrics are the number of patient encounters, transfers to hospitals vs. Also tracked is the number of missed appointments, which at the center have declined to the point where the number of no- shows is now lower for telehealth appointments than for traditional in- office appointments. Other parameters are dictated by the specialty service line. By finding the right mix of services and the right technologies across which to deliver them, telehealth can increase access to healthcare while reducing costs and improving outcomes. It can also have some unexpected side effects that expand its economic benefits to the community at large. Roop is a Tampa, Fla.- based freelance writer specializing in healthcare and HIT. The Reimbursement Conundrum. Reimbursements are always a concern when a new service line is introduced, and telehealth is no exception. While reimbursing for services provided via telehealth is growing more prevalent, it still remains a large obstacle to more widespread adoption. According to Karen Rheuban, MD, director of the University of Virginia (UVA) Center for Telehealth, the Centers for Medicare & Medicaid Services (CMS) reimbursed just $1. After hearings in 2. Medicare beneficiaries. Annually, CMS reimburses only about $2 million of telehealth services nationwide. We need to change that paradigm. The American Telemedicine Association notes that telehealth applications such as tele. ICU, telestroke, telerehabilitation, home telehealth, and remote patient monitoring could be incorporated into those bundled payments. The battle is also under way at the state Medicaid level. For example, the UVA center worked closely with Virginia. We showed that our institutional investment in telehealth did indeed bear fruit. Currently, more than 3. Medicaid programs cover some telemedicine services, and 1. Virginia, have implemented mandatory telemedicine reimbursement legislation. Part of the reimbursement challenge is the wide range of variances within the U. S. This can make it difficult to determine what is an appropriate service and fair reimbursement rate, particularly at the national level. It remains a difficult sell. According to the Health Resources and Services Administration, there is no single widely accepted standard for private payers. Some value the benefits of telehealth and will reimburse a variety of services, while others have yet to develop comprehensive reimbursement policies. Despite these challenges, reimbursement is happening. And many expect it will grow exponentially as new care models take hold.
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