Assessing Telehealth’s Value

A typical value-based care contract (VBC) is extremely complicated, but gauging the overall value something brings is much easier – and telehealth delivers amazing value.

Recently, at the American Association of Nurse Practitioners’ Specialty & Leadership Conference, family nurse practitioner Thanh Nguyen from Providence Health Express in Oregon noted that “we don’t know” what telehealth’s return on investment will be in the new value-based care model. Only about 40% of providers are even using VBC contracts, which means that six out of 10 providers are still using the fee-for-service approach.

But Nguyen is certain about one thing: telehealth is providing undeniable value every day. In her view, it’s saving lives and improving access to care while offering growth opportunities for nurse practitioners.

Nguyen feels that it’s now time for legislators and regulators to bring more telehealth value to clinicians – namely, getting paid for every hour worked.

In a recent speech, the American Medical Association’s immediate past president, Dr. Steven Stack, spoke about the need for a “quadruple aim”: adding “clinician satisfaction” to the current trio of improved access, better care and lower costs. “We need to restore joy to the practice of medicine,” he said – one way to do that is fair compensation for the long hours worked.

Current reimbursement policies don’t allow telehealth providers, like Nguyen, to get paid a penny for the time it takes to respond to patients’ emails. She’s licensed to practice only in Oregon and Washington, and she recently got burned by a Nevada patient who claimed to be visiting friends in Oregon. Ultimately, Nguyen had to waive her fee for the 20-minute session.

The healthcare industry’s journey to value-based care is a worthy effort, but it will only succeed when it brings real value to the clinicians who make it happen – and when it fairly compensates them for the care they provide via telehealth technology.

How Telemedicine is Transforming Senior Health Care

How Telemedicine is Transforming Senior Health Care  


By Julie Potyraj – Guest Blogger

Polly, age 78, and suffering from obesity-related health issues, is sitting on her sofa on a snowy afternoon. At 3 p.m., it’s time for her wellness appointment. Polly turns on her iPad (supplied by her doctor’s office), and sees her physician’s face smiling back at her. The doctor has already received information on Polly’s blood sugar levels, heart rate, and blood pressure via a remote monitoring system that sends the data directly to his office. After chatting for a bit, Polly shows the doctor a mild rash on her arm. Upon evaluating the condition—made possible by high-definition video conferencing equipment—her physician recommends a round of antibiotics and transmits a prescription to the local pharmacy. Thirty minutes later, the appointment is over, and Polly hasn’t left the warmth and comfort of her home.

This scenario is not from some futuristic film—it’s telemedicine, and it’s gaining momentum in health care settings across the world. Also referred to as telehealth, telemedicine is defined by the industry as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.” This is more than just a trend; 52 percent of hospitals already use remote technologies to deliver clinical services.[1]

The Impact for Seniors and Health Care as a Whole

For aging adults with mobility and transportation problems, telemedicine can offer a welcome respite from in-person office visits. Frequent doctor’s appointments become less of a strain for seniors as well as their caregivers, who often must take time off work to accompany their loved one.

The early intervention afforded by telehealth also helps prevent unnecessary emergency room visits and hospital readmissions. While this is good news for patients themselves, it also helps ease the burden on America’s health care system by improving efficiency and reducing costs. Consider the following real-world examples:

  • An Illinois-based skilled nursing home chain is using telemedicine to minimize readmissions and eliminate unneeded ER visits, saving the health system hundreds of thousands of dollars annually. Through this program, which involves using video teleconferencing to enable bedside evaluation by board-certified physicians, approximately 81 percent of patients using the technology can be treated on-site.
  • In North Carolina, telemedicine is helping seniors diagnosed with diabetes, COPD, and heart failure remain in their homes and out of the hospital for longer periods. This is accomplished by monitoring these patients remotely in between skilled nursing visits using specialized telehealth technologies.

Medicare is Warming to Telehealth

In 2015, the Centers for Medicare & Medicaid Services (CMS) delighted telemedicine advocates by adding seven new payment codes covering additional telehealth services, such as annual wellness visits and psychotherapy. However, there is still work to be done. In an effort to help all Medicare recipients enjoy the benefits of telemedicine, organizations such as the American Telemedicine Association continue to actively encourage CMS and Congress to eliminate the arbitrary restrictions that limit coverage.
Would you like to be on the cutting edge of telemedicine and other health care issues? Learn more about MHA@GW, the online master of health administration from the Milken Institute School of Public Health at The George Washington University.


[1] American Hospital Association. The Promise of Telehealth For Hospitals, Health Systems and Their Communities. Trendwatch. January 2015.


Telehealth for Seniors

Skilled Nursing Facility using telehealth

Retooling Primary Care

For decades, the entry point in healthcare was the primary care physician’s office. That’s changing rapidly as retailers like Walgreens and Walmart ramp up their efforts. The first wave of retail medicine has been described as a “nurse practitioner in a closet.” But in 2015, we’ll be seeing many retail locations that offer everything a traditional PCP does…and often a whole lot more.

This trend is great news for telehealth providers. Most retail medicine operations are just barely beginning to make a profit. They can become more successful by partnering with telehealth companies that don’t have a comparable investment in brick-and-mortar offices and can leverage scalable, cloud-based technologies.

For example, if nurse practitioners at a retail site wants a quick second opinion, they can get one via telehealth without having to send the patient to a nearby primary care doctor. That keeps more money in the system, both for the retail provider and the telehealth partner.

The rapid growth in both retail medicine and telemedicine is fueled by patients’ desire for greater convenience and faster access to care. A recent Advisory Board story highlighted some of the reasons why Americans have so quickly warmed to retail medicine:

Easy online scheduling – The appointment portals at places like CVS and Walgreens are simple to use – and provide far greater convenience than what most urgent care clinics and EDs currently offer.

Extended hours – Unlike most PCPs, the caregivers at retail clinics work evenings and weekends.

Monitoring chronic conditions – Retail clinics are already adept at helping patients manage and monitor ongoing health problems like diabetes and hypertension.

Deep pockets for clinic upgrades – Retail giants have far more cash than your local PCP for things like the newest medical devices and EMR enhancements.

This will be the year when the synergy between retail medicine and telehealth becomes mutually profitable. The public has made it very clear: give us greater access and more convenience beyond the 9-to-5 limitations of traditional medicine.


Mixed Messages

When you scan the telemedicine headlines, there’s always cause for celebration – along with moments that make you scratch your head in disbelief.

                    Let’s start with the good news:

 Last month, the Federation of State Medical Boards (FSMB) approved a model policy on telemedicine that is strongly supportive of today’s acute care telemedicine. One excerpt reads, “Generally, telemedicine is not an audio-only telephone conversation, an e-mail/instant messaging or a fax. It typically involves the application of secure videoconferencing to provide or support healthcare delivery by replicating the interaction of a traditional encounter in person between a provider and patient.”

 Audio-only telehealth providers immediately put up a big howl, but FASB got it right. A phone call is no substitute for being able to clearly see and interact with a patient.

 And now for the troubling news: the medical licensing board in Idaho doesn’t share the enthusiasm for telemedicine seen in other states. In fact, the Idaho board recently placed serious sanctions on Dr. Ann DeJong for simply prescribing an antibiotic over the phone. The sanctions included a license restriction (preventing her from doing long-distance consults) and a $10,000 fine.

 Mind you, those sanctions took place in a state that has one of the most innovative telemedicine programs in the nation: the St. Alphonsus Idaho/Oregon Telemedicine Network.

 Ironically, the Idaho legislature recently passed a bill calling for healthcare stakeholders to set new – hopefully, more progressive – standards for telemedicine.

 Maybe it’s time for the Idaho board to read the entire 11-page FSMB model policy report – and consider reducing the penalties for Dr. DeJong.



Wisdom Shortage Creates Doctor Shortage

We’ve all seen Clint Eastwood westerns where the sheriff says, “We can’t treat him here…the closest doctor is in Dodge City.”

Without telemedicine, that’s the future we’re all facing. In little more than a year, some 30 million new patients will enter the U.S. healthcare system – the equivalent of every man, woman and child inVenezuela. Meanwhile, the Association of American Medical Colleges (AAMC) predicts that the physician shortage in America will reach 130,000 by 2025.

Legislative caps on residency funding will only worsen the current physician shortage.

One of the main reasons for the shortage is that the federal government has capped its funding for doctor residencies. Because there are so many deficit hawks in Congress now, it’s unlikely that the cap will be increased anytime soon – and efforts at private funding have stalled. You know we’re in trouble when a Congressman named “Price” (Tom Price, R-Ga.) bemoans the price of training physicians, but can’t muster the votes to change things.

Atul Grover, the AAMC’s chief public policy officer, recently said that “we’re going to have to find ways to see more patients with fewer physicians” to handle the increased volume.

And that’s exactly what telemedicine is doing. While politicians dither and medical schools stay in no-growth mode, telemedicine is enabling the doctors we do have to extend their reach. In fact, telemedicine solves one of today’s thorniest problems: the need for doctor relocation. These days, a young doctor can improve the quality of care in rural communities without ever leavingPhiladelphia or San Francisco.

Like a storm blowing through a western town in that Clint Eastwood movie, there’s a perfect storm on the horizon: millions of new patients, not enough doctors. That storm may be strong enough to blow away all remaining barriers to telemedicine.