by Marcia M. Ward, PhD, Director of the Rural Telehealth Research Center
What I’m hearing now from people and seeing is the slow migration away from fee-for-service and moving more toward paying for value or sharing the risk. That’s when you start thinking about telehealth in a different way, especially if you are a healthcare provider who’s looking at how to pay for it while providing the best population healthcare. It’s been a long battle, but state by state, we are seeing legislation pass that removes or reduces some of those historical barriers like licensing and credentialing. And in the states that are passing parity laws, we are seeing some of the reimbursement disparities decrease.
The brand new challenge that I’m hearing is scalability. I think that’s a sign of the actual growth in telehealth. It’s getting past the initial childhood stage that it has been locked into, and now people are beginning to look at telehealth as having a business case. Maybe you are not at the level that Avera eCARE is, or you haven’t permeated a whole region of the state the way they have at the University of Mississippi Medical Center: Center for Telehealth. Maybe you can see a way telehealth could fit in with all of your services, but how do you build that from scratch? How do you staff something when you don’t have much patient flow initially? So there really is a scalability challenge: How do you execute a business model where you have to staff people for a specialized service when you have low demand until you build up the clientele?
It’s getting past the initial childhood stage that it has been locked into, and now people are beginning to look at telehealth as having a business case.
I think it starts with the leaders of a healthcare organization. They need to believe in the telehealth mission and are successful because they deliver on it in a way that meets the needs of both patients and providers. Topics that I publish about are specialized hospital-based services: telecardiology, telestroke, teletrauma, and telehospitalist. If you want to start one of those services, it really takes a lot of staff investment and you need an incredible champion of that.
Clearly, telehealth will grow as reimbursement models change throughout the larger national healthcare arena. We can contribute to the evidence base for telehealth to help inform healthcare payment policies. The specific purpose of our HRSA-funded Rural Telehealth Research Center is to help build the evidence base. And that’s what so many of us working in this field can do: keep contributing to those studies, conducting fair comparisons, and showing where telehealth is comparable to face-to-face encounters or where it may even have advantages like reducing patient costs. Documenting those things is building that evidence base.