New flexibilities for telehealth reimbursement and expected changes for 2019 and beyond are making its use more widespread.
Providence St. Joseph Health headquartered in Washington State, has been working for over 12 years on its telehealth program and the technology, in fact, has become necessary as a way to leverage the scarce resources of physicians and nurses, a problem facing all hospitals, said Kim Swafford, group vice president of telehealth and health technology strategy for Providence St. Joseph Health.
"Providence St. Joseph has 51 hospitals across seven states, we represent a lot of rural communities," Swafford said. "How do you take those scare resources and scale them appropriately?"
One primary virtual focus is telepsychiatry; another is a telehealth ICU model in two states, Alaska and Washington. In these states, patients may not have easy access to specialists, Swafford said.
A telehealth ICU has a virtual hub of critical care nurses who are monitoring patients in remote communities. One example is sepsis management.
Providence St. Joseph also established a platform for telestroke that started on January 1. The program was able to get reimbursement from Medicare due to policy changes.
For any telehealth program to work, Swafford said, providers must ensure that their clinician and administrator teams are aligned. Then they must leverage the right technology.
Most telemedicine initiatives begin with products to help a consumer get access to a doctor, said Tim Wright, chief strategy officer for InTouch, a telehealth and telemedicine virtual care platform.
At Providence St. Joseph, he said, "We started at the other end of the healthcare continuum to virtualized care starting with highly acute inpatient scenarios, where access to the right specialist is life saving."
The healthcare industry is on the cusp of significant change in telehealth, according to
Until recently, the underlying philosophy from the Centers for Medicare and Medicaid Services, was that telehealth would increase the cost of care because it created more opportunity to bill Medicare, he said.
It was allowed in rural areas, for certain billable codes, about a dozen in number. Even though Medicare is now up to about 96 allowable codes, there has been the rural limitation constraint.
Over the last 12 months, both Congress and CMS have come around to the power of virtual health, not to increase costs but to drive them down, he said.
Sixty-percent of telestroke sites are now in urban areas, Swafford said.
A handful of new legislation in 2018, including the Bipartisan Budget Act, included new flexibilities for telehealth, and more are expected in 2019.
In fee-for-service Medicare, CMS chose to end the rural designation for telestroke and end-stage renal disease.
CMS is allowing Medicare Advantage plans to have patients get reimbursed for telehealth services from home, starting in 2020.
"They don't want to open the doors all at once," Wright said of CMS. "It was an easy one to do for Medicare Advantage. Now it's you submit an application for a Medicare Advantage plan and get it authorized, and you can provide telemedicine services and get paid as a MA plan in 2020."
Swafford and Wright are scheduled to discuss this topic during the HIMSS19 session, "Telehealth Reimbursement: The Times They Are A Changin'!" from 4-5 p.m., Wednesday, Feb. 13, in room W303A, at the Orange County Convention Center, Orlando, Florida.
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