Guide: Telemedicine benefits held back by lack of reimbursements
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BOSTON -- Depending on who you ask, the nation is either in the middle of a shortage of primary care physicians, or soon will be. Some have floated the idea that the burgeoning use of telemedicine services, such as remote patient monitoring and video consultations, could compensate for this shortage. However, attendees at the Partners HealthCare Connected Health Symposium said certain conditions will need to change for telemedicine to positively impact the physician shortage.
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A 2012 study from the American Academy of Family Physicians showed that just 9% of all medical students enter primary care. This trend is partially the cause of the shortage. The Health Resources and Services Administration estimates it would take an additional 15,297 practitioners to adequately serve the 55 million people living in areas with the greatest unmet medical needs. Things may get worse before they get better, as the Association of American Medical Colleges has estimated that the U.S. will face a nationwide shortage of more than 159,000 physicians by 2025.
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With millions of people set to receive health insurance in the coming years thanks to the Affordable Care Act and an aging population, health resources may be stretched thin.
"It's a huge issue that we'll have to grapple with," said Hon Pak, M.D., CEO of Diversinet and past president of the American Telemedicine Association. "What was a moderate problem in provider shortage has now become a very severe shortage."
He said telemedicine services can help doctors make more efficient use of their time. Additionally, they can make managing chronic disease patient populations easier, something that will become important as payments move away from fee-for-service models and move toward accountable care. However, it remains difficult for practices to fully implement telemedicine because the list of remote services that are fully reimbursed remains short.
"We need to take a more proactive approach, but the problem right now is we don't get any reimbursement for that," Pak said. "Until the reimbursement changes we're going to be in a difficult situation."
Adam Darkins, M.D., chief consultant for telehealth services at the U.S. Department of Veterans Affairs, said a lack of reimbursement for telemedicine is a problem holding back broader use. He said medical facilities coordinate their services to fit payment models, which means in the current fee-for-service world doctors focus most of their attention on patient office visits.
Until we can make the science and technology we're talking about the new normal and not the new innovation, I think we're going to have a challenge.
director, Massachusetts Institute of Technology's AgeLab
But there is growing pressure to bring care to where the patients are, which is not limited to the doctor's office, Darkins said. Patients who have chronic conditions like diabetes or heart failure require regular treatment, and it's not always practical for them to come to their provider. A growing number of U.S. patients dealing with chronic health problems will create demand for remote services. Darkins expects this to put pressure on payers to start reimbursing for a greater number of telemedicine services.
"As you change the location and the nature of care, and find ways to reward correct decision making, we may need new forms of payment," he said.
Another barrier to bringing telemedicine into the mainstream to help with the growing doctor shortage is the need to develop systems that avoid inundating physicians with data. Joseph Coughlin, director of the Massachusetts Institute of Technology's AgeLab, said that new systems of care that rely heavily on data, such as remote monitoring services, run the risk of giving doctors more information than they know what to do with. Eventually, doctors may start tuning out vital pieces of data.
Overloading physicians with information may even worsen the doctor shortage, Coughlin said, as clinicians may start to view their IT systems as a burden, which could strain health resources that are already stretched thin.
"I'm not sure physicians are ready to take in that much more input to make decisions," Coughlin said. "With the average doctor being 53 and not many people coming into general practices after them, I'm not sure that added burden is going to be welcome."
With the shortage of physicians continuing to intensify, solving the problems that hold back the use of telemedicine could play a role in ensuring more patients receive the care they need. Darkins said he is sure more care will eventually be delivered remotely. As payers and providers see the benefits of telemedicine, they will eventually increase support for this kind of care.
"Whether it's telehealth or mHealth, I don't really mind what you call it. This is just what health care is going to look like in the future," Darkins said.
Coughlin said that until health care reaches that point where telemedicine is the standard of care, the industry will continue to struggle with the problems of high costs and poor outcomes.
"Until we can call telemedicine 'medicine,' we have not made it yet," he said. "Right now we're calling it connected health. But until we can make the science and technology we're talking about the new normal and not the new innovation, I think we're going to have a challenge."