Hospitals and telehealth: Promises, challenges

Physician practices aren’t the only healthcare providers using telehealth. Hospitals and hospital systems are doing so as well.

In January, the American Hospital Association published “TrendWatch: The Promise of Telehealth for Hospitals, Health Systems and Their Communities.” In it, the AHA reports that the technology holds promise to increase access and patient satisfaction, and to reduce readmissions and costs. But it also faces operational challenges.

In 2013, 52 percent of hospitals used telehealth, and another 10 percent were beginning the process of implementing telehealth services, according to AHA. Recent studies on the use of telehealth services have shown that:

74 percent of U.S. consumers would use telehealth services.
76 percent of patients prioritize access to care over the need for human interactions with healthcare providers.
70 percent of patients are comfortable communicating with their healthcare providers via text, email or video, in lieu of seeing them in person.
30 percent of patients already use computers or mobile devices to check for medical or diagnostic information.

For several years, the Veterans Health Administration (VHA) has used telehealth for home health monitoring to track vital signs and conditions for patients with chronic diseases or who have been released recently from the hospital, reports the AHA. The VHA reported that telehealth services in its post-cardiac-arrest-care program resulted in a 51 percent reduction in hospital readmissions for heart failure and a 44 percent reduction in readmissions for other illnesses.

Coverage and payment
Coverage and payment issues present some of the greatest challenges for providers seeking to implement telehealth, notes the AHA.

“On the public payer front, inconsistencies exist. For example, Medicare’s policies for coverage and payment for telehealth services lag far behind other payers due to its restrictive statutes and regulations. Many state Medicaid programs cover telehealth services to some extent, although the criteria for coverage vary widely from state to state. On the private payer side, by contrast, there has been significant expansion, with many states passing laws requiring private payers to provide coverage for telehealth services.” The American Telemedicine Association reports that 20 states and the District of Columbia have enacted so-called “parity” laws, requiring insurers to pay for telehealth services the same way they would cover services provided in-person.

Heart failure program
Geisinger Health Plan, a managed care organization serving patients primarily in rural central Pennsylvania, has operated a heart-failure telemonitoring program since March 2008, according to the AHA. Geisinger gives patients Advanced Monitored Caregiving Bluetooth scales with an Interactive Voice Response (IVR) system, which is used with landline or cellular phone service to transmit weight measurements and to take the IVR calls.

Geisinger researchers reviewed claims data for patients enrolled in the program from January 2007 through October 2012. In a given month of the study, patients enrolled in the program were 23 percent less likely to experience a hospital admission. The odds of experiencing a 30-day readmission were 44 percent lower, and the odds of experiencing a 90-day readmission were 38 percent lower than patients not enrolled in the telemonitoring program. Also, the program was associated with approximately 11 percent cost savings during the study period.

Healthcare reform and telehealth
Given the Affordable Care Act’s emphasis on clinically integrated care models, telehealth should only grow in its usage, says the AHA. In a proposed rule published in December 2014, for example, the Centers for Medicare & Medicaid Services proposed requiring accountable care organizations (ACOs) to describe in their applications how they will encourage and promote the use of technologies such as telehealth services to improve care coordination for Medicare beneficiaries.