The Growing Emergence of Telehealth

The United States spends more on healthcare than any other developed country in the world.  In 2015, the United States spent an estimated $9,523 per person on healthcare, which accounts for approximately seventeen percent (17%) of the Gross Domestic Product. Contrary to how much the country spends on healthcare per capita, twenty percent (20%) of Americans reside in areas that experience physician shortages, and the United States is still lacking in health care efficiency and patient access to care.  To improve the country’s position in healthcare delivery, a growing phenomenon has emerged in the field of healthcare known as telehealth (also known as telemedicine). 

Telehealth is the use of technology, specifically electronic devices, to deliver healthcare services through the exchange of medical communication between the physician and patient. One outlet utilized in telehealth is applications on a patient’s smartphone, including applications such as Live Health Online, First Opinion, Health Express, and Stat Doctors, which a patient can use to communicate with physicians and exchange healthcare information.  Such applications foster a one-on-one interaction between the physician and patients without the physical contact of in-person physician visit.  The services provided via telehealth are threefold: store-and-forward services, real-time communication, and remote patient monitoring.  Store-and-forward services entail the transmission of medical data for a physician’s assessment at a later time. This type of service is best for diagnosis and treatment recommendation purposes.  Real-time communication deals with the use of audio and visual equipment to simulate a typical physician appointment with the patient and physician viewing each other through some form of electronic device.  Remote patient monitoring relates to the tracking of a patient’s health status once they are released, or admitted to a healthcare facility, with the goal of reducing readmission rates.

 Telehealth can bring several benefits to the healthcare field.  First, telehealth can increase healthcare access for patients in rural areas where there are fewer physicians. Through real-time communication patients have the opportunity to access physicians without requiring the physicians to physically meet patients.  This reduces time and resources spent by both parties on consultation.  Second, due to remote patient monitoring via electronic devices, chronic disease patients may potentially receive better care.  Remote monitoring enables physicians to more thoroughly monitor patients thus potentially reducing hospitalizations and lengths-of-stay, as well as assuring that patients adhere to their medications.  Telehealth, therefore, creates avenues for healthcare practitioners to dedicate more time to patient treatment.  Some commentators have pointed to telehealth being a means to reduce health care spending.  Using remote patient monitoring to reduce unnecessary tests and visits alone is expected to create savings of up to $3.61 billion. Additional savings can be achieved through a reduction of referrals to outside specialists from emergency departments because specialists are able to monitor patients remotely.

Although telehealth opens the doors to a more efficient healthcare delivery market, there are some issues that still need to be addressed. One issue is the risk that pursuing telehealth may lead to a breakdown in physician-patient relationships due to the lack of consultations and in-person meetings.  Because patients can meet remotely with their doctors via electronic devices, there is less of an incentive to do in-person consultations.  The lack of incentive for in-person consultations can affect the quality of the consultation that the patient recieves.  In a Forbes Insights survey of business executives, Forbes found that people did not devote their full attention during virtual meetings.  Although telehealth deals with the healthcare sector rather than the business sector, in-person meetings create an atmosphere in which attendees pay more attention to each other.  This lack of attention during virtual consultations is of heightened importance because we are dealing with matters of health.  As such, full attention will lead to better consultation and guidance.  Another prominent issue is the concern over reimbursements.  Medicare reimburses telehealth services related to real-time communications but not store-and-forward or remote monitoring patient services.  The services commonly reimbursed are consultations, office visits, and some physician fee schedule services, although restrictions do apply.  Some states have begun to implement telehealth coverage laws creating guidelines for reimbursements by Medicaid.  These guidelines create a pathway for reimbursement for live video telehealth, store-and-forward services, and at least some form of remote patient monitoring.  Lastly, one of the greatest concerns has been telehealth parity laws.  Telehealth parity laws demand reimbursements by health insurance companies for telehealth services at the rate equal to in-person services.  This has created a rift among supporters and opponents of telehealth.  Those that support telehealth point to its ability to improve healthcare delivery, while opponents argue that telehealth should not be equated to in-person services to produce the same reimbursement rates.

Regardless of what ones opinion on telehealth, it is a growing area of healthcare that has already begun to change the healthcare delivery landscape.  The popularity of telehealth has led Congress to consider the Medicare Telehealth Parity Act of 2015, a nationwide telehealth parity law.  The Act would entail an expansion of the geographic locations in which telehealth services operate, expand telehealth coverage for Medicare beneficiaries, and increase coverage of telehealth services.  Although the chances of enactment are unclear, the fact that Congress is considering a nationwide telehealth law illustrates the impact that telehealth is already having on healthcare in the United States.  Because of its potential to reduce healthcare costs, improve access to healthcare, and better monitor patients, telehealth is among the most attractive healthcare initiatives.  As it becomes a more dominant part of patients’ lives, additional state and federal guidelines will help shape the structure of telehealth coverage in the American healthcare system.

Faizan A. Khan is a third year law student at DePaul University College of Law. Mr. Khan graduated cum laude from DePaul University with a Bachelor of Arts in Political Science and minor In Economics. He is a currently serving on the DePaul Journal of Health Care Law and will complete his J.D. in May 2017.