Provider: Lack of alignment between reimbursement, care quality holds telemedicine back

Telemedicine and mobile technology are becoming more mainstream ways to help patients in rural communities, reduce healthcare costs and improve outcomes.

In a recent interview in Healthcare Informatics, two leaders who work in telemedicine--James Marcin, director of the pediatric telemedicine program at UC Davis Children's Hospital, and John Thomas, director of telemedicine at Children's Hospital Colorado--talked about their experiences with telemedicine and the impact of mobile technology in the field.

Both emphasized how the technology allows primary care providers to work remotely to service rural areas.

Marcin, who also works as a professor of pediatric critical care at UC Davis, said his hospital serves many rural counties in Northern California. To that end, he said by using telemedicine, providers are able to help sick children in those areas receive specialty care.

Physicians, he said, now can do consultations from their offices, instead of the clinic, and can work remotely from laptops or iPads.

Care access improvement also is a big reason Children's Hospital Colorado uses telemedicine, according to Thomas.

"Our efforts are aimed at how telemedicine opportunities apply to our strategic initiatives to improve outcomes, reduce costs, and improves access," Thomas said.

The platforms, he added, enable organizations to perform home-based or specialty care follow-ups with patients and integrate behavioral health into primary care settings; this allows for better coordination of care and may prevent re-hospitalizations.

The rural focus Marcin and Thomas discussed mirrors how telemedicine is a growing option for rural healthcare facilities across the country. However, regulatory issues can impede that treatment.

Marcin said using telemedicine and mobile tech has its costs--technology is far ahead of rules and regulations when it comes to care reimbursement.

"We are not paid to keep people healthy; we are paid to see patients in clinics," he said. "In my opinion, the biggest barrier is the lack of alignment between reimbursement and providing quality of care."

The American Telemedicine Association conducted an online poll in 2012 of its members and others about their experiences with reimbursement for telehealth services. Forty-eight percent said they did not provide telemedicine services because they were not reimbursed, while 55 percent continued to provide services even without being paid.

The two leaders also spoke about value-based purchasing in healthcare and its potential impact on payers. Marcin said he hoped that it would make telehealth more attractive, adding that there is still a long way to go to move from "volume to value." In health systems where incentives are more aligned, there is a lot of mobile and home health, Marcin said..

Thomas said his institution is working on population health-oriented pilots--which are all in areas where telehealth plays a role, including handling specialist consults in rural places, transitions from hospital to home and having patient intake and discharge be more efficient.

To learn more
- read the interview

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