The cost of innovation is often the determining factor when predicting the likelihood of sustainability. In regards to expanding telehealth capabilities, Nebraska’s Senator Nicole Fox, and many others, state that it is the cost saving capabilities of telehealth that should make it a priority in our government and healthcare organizations.2
In my discussions with Sen. Fox, her passion for promoting the use of telehealth was apparent; so, I felt obliged to ask her what was stopping bills that promote things like parity pay from passing in the legislature. Sen. Fox advised anyone who hopes to create sustainable change to first create awareness. She informed me that while she is a healthcare provider herself (hospital nutritionist) and has a basic understanding of reimbursement processes, many legislators do not have that personal experience or even knowledge of the ins and outs of healthcare reimbursement. She suspects that some people in leadership (i.e. decision-making) roles may not always understand the consequences of what they are turning down.2 Sen. Fox affirms that government leaders such as herself rely on advocates and experts to provide awareness and information regarding issues that need to be brought to their attention.2
Payers have long disputed the forecasted financial savings telehealth could offer them. The lack of firm data to support the savings made commitment to up-and-coming technology difficult. However, with time and experience, many payers are beginning to recognize the financial benefit for themselves, their rural members as well as the city-dwelling “Netflix generation, who expect on-demand services.”1 This financial benefit comes from reduced ED visits, hospitalizations, complications, and improved efficiency of care.
I argue that private payers must provide parity pay for telehealth services; however, it is certainly of mention that many healthcare organizations will remain slow to adopt telehealth capabilities until Medicare expands their coverage (only $17.6 million of their $634 billion was paid towards telehealth services).1 Medicare has expressed concern that telehealth services will only become an add-on to the current standard of care (rather than replacing irresponsible use of resources) thus costing them significantly more money rather than resulting in cost-savings.1
In addition to mandating private payer parity, making telehealth sustainable will require a more open line of communication between the payers, providers, and patients. Many healthcare providers who do not utilize telehealth services state that they have no idea which payers reimburse for telehealth services or at what rate so they avoid it all together.1 Similarly, many patients who pay for plans that provide telehealth services are not aware that telehealth is an option for them.1 It is thought that as more consumers experience telehealth, they will soon be demanding these services leading to quicker action.
It seems anytime government policy is discussed, the question arises of whose interest policymakers have at heart. Private payers (or CMS for that matter) have historically had a difficult time envisioning the savings this initial investment can offer. Unfortunately, their loud voices and deep pockets often stifle the concerns of the consumer (time away from work and family, travel costs, lost productivity, traffic, air pollution, etc.). As Senator Fox advised, we must speak up, advocate, and make our needs and desires known. As consumers or representatives of consumers, we must educate those in power of deciding what healthcare services we can receive.
- Herman, B. (2016). Virtual reality: More insurers are embracing telehealth. Modern Healthcare. Retrieved from http://www.modernhealthcare.com/article/20160220/MAGAZINE/302209980.
- Senator Nicole Fox, personal communication, February 9, 2016