Telemedicine Moves Into Mainstream as More Employers Offer It

With 15 states now requiring insurers to cover electronic medical consultations and treatments, telemedicine is not so much an emerging trend as one that has arrived.

What began as a way for patients far from specialized care to connect with a doctor, is evolving into an increasingly popular way for workers to avoid taking time off for minor illnesses. While tech giants provide onsite clinics and doctors for their workers, telemedicine allows even SMB employers to provide a similar, if not identical, service for their workers.

In Hospitals and Health Networks Most Wired 2011 survey, 27 percent of physician offices and 42 percent of hospitals reported offering some kind of telemedicine service. Those percentages are even higher today, as insurers expand their coverage — whether because they must by law or, as Blue Cross/Blue Shield did in North Dakota a decade ago, because it is cost-effective.

Large employer offering telemedicine services

Employers are beginning to insist on coverage of teleconference consults, as well as for the medical equipment that is sometimes needed to remotely  monitor certain types of patients — cardiac cases, for instance — who might otherwise be hospitalized for monitoring.

Some of the largest employers who have their own health centers are adding or will soon offer telemedicine services. A Towers Watson survey of onsite health centers this year said 28 percent of employers will offer telemedicine benefits by the end of next year, up from 8 percent now.

Notes the report:

In addition to onsite centers, organizations are looking to telemedicine as another way to reduce time spent in doctors’ offices and delays in securing appointments. The decrease in travel and wait times associated with visits to primary care physicians can have a direct impact on employee productivity. It reduces time away from the work site as well as time lost at the work site due to worries about a health condition or making appointments. Telemedicine is being used both on a stand-alone basis and as a complement to onsite services.”

Some employers are opting to offer a supplemental type of telehealth service. Often an adjunct to an employer health plan, these programs enable workers who opt in  to have access to a doctor 24/7. Most of these supplemental programs offer direct physician consults, including diagnosis and prescriptions, but only for a limited number of conditions. Outside these, patients are directed either to their local doctor or, in serious cases, to an emergency room.

“This model works because you can be seen when you want as quickly as you want,” said Dr. Alan Roga, speaking at a Benefits Forum & Expo last month. The CEO of STAT Doctors, Roga called telehealth benefits a great “turn-key solution for the employer.”

Employees generally cover the costs

Some of these programs are fully paid by the employers. In more cases, the employee covers the cost of participation themselves. They are also open to consumers, generally.

Consult A Doctor started as a direct to consumer service, but began offering the telephone consultation service through employers a few years ago. It may seem redundant to have both a traditional health plan and a telemedicine program. However, companies that provide both, say the benefit of the latter is that it provides immediate access to a doctor who can prescribe medication, which cuts down on absenteeism and missed time while employees wait to see their regular physician.

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Robert Reers, Northeast regional benefit practice leader for USI Insurance Services, says the company began offering the Consult A Doctor service a year ago. “We saw a need for our clients in terms of access to primary care physicians,” he says. “We look at it from a productivity and absenteeism standpoint as well as being able to provide employees with greater access to care.”

Rent-A-Center, a nationwide furniture rental company, began offering a telehealth service from Teladoc Inc. last year and so far, has saved almost $800,000 in direct health costs and lost productivity.

A tangle of  licensing laws and rules

Like all health benefits, these standalone supplements have ERISA implications, and may also has consequences for employees with Health Savings Accounts. Reers, of USI, says his company involves compliance attorneys to review the programs employers want.

One of the other curbs on the growth of telemedicine is the tangle of licensing laws and rules regulating the practice of medicine. The Federation of State Medical Boards has a “Telemedicine Overview” posted on its site, which lists the rules by state regulating the practice. The overview is 18 pages long.

Frustrated by the regulatory web, the American Telemedicine Association last year launched FixLicensure.org, to reform U.S. medical licensing as it relates to providing medical services in other than face-to-face settings in the same state where the doctor or other practitioner is licensed.

Medicare is less progressive when it comes to home health care via teleconferencing or other electronic systems. Professionals will be reimbursed for consultations and medical services, including psychotherapy, but only to patients is approved facilities. Home services are not yet covered, except for some limited types of monitoring services.

John Zappe is the editor of TLNT.com and a contributing editor of ERE.net. John was a newspaper reporter and editor until his geek gene lead him to launch his first website in 1994. He developed and managed online newspaper employment sites and sold advertising services to recruiters and employers. Before joining ERE Media in 2006, John was a senior consultant and analyst with Advanced Interactive Media and previously was Vice President of Digital Media for the Los Angeles Newspaper Group.

Besides writing for ERE, John consults with staffing firms and employment agencies, providing content and managing their social media programs. He also works with organizations and businesses to assist with audience development and marketing. In his spare time  he can be found hiking in the California mountains or competing in canine agility and obedience competitions.

You can contact him here.

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2 Comments on “Telemedicine Moves Into Mainstream as More Employers Offer It

  1. John, I work for GlobalMed and we are the industry leader in designing the next generation of medical care, often called telemedicine.  As it happens, I used to work for the Arizona Medical Board, the agency that licenses MDs.
     
    Regarding your post, so far the only proposal to solve the licensure barrier issue comes from New Mexico Democratic Senator Tom Udall. Since his draft calls for a new level of bureaucracy and increased spending, it has not attracted any Republican co-sponsors and is unlikely to make any headway in the next Congress IF it is ever introduced.  The Federation of State Medical Boards opposes it because it takes away state jurisdiction, especially in terms of investigating complaints against bad doctors.  Plus, medical boards would lose thousands of licensees (and millions of dollars). Doctors who maintain medical licenses in multiple states would simply let those they aren’t using expire.

    Why not borrow from a system that is already in place and working to deliver healthcare via telemedicine across state lines – the VA. What is most needed in rural and medically underserved America? Specialty care. Few specialists live or practice outside larger urban centers.
     
    Let’s see how a solution fits with the VA model. Currently, a physician licensed somewhere in the U.S. can practice medicine anywhere in the VA healthcare system.  They do not have to be licensed in multiple states as long as their practice is limited to patients on a VA campus.

    Already, medical groups like the Mayo Clinic are operating Telestroke Networks.  Why not license Mayo to deliver neurology care via telemedicine to all states in the United States?  Let neurologists licensed in one state work across state borders if employed by Mayo.  Mayo would be responsible and have a duty to report any bad acts by one of its neurologists to the state medical board(s) where the specialist was licensed.  This is currently done by hospitals within a state when they begin gearing up a peer review committee to investigate a physician with privileges. 

    In this way, oversight is still at the state level – no need for an extra federal bureaucracy. State medical boards might lose a few dozen multiple licensees, but not the thousands, so there would be no dramatic drop in licensure fees.

    This could be the model for all specialties.  Cleveland Clinic could be the national telecardiology service. Kaiser-Permanente could become the teledermatologists, and so on. Of course, each of these larger entities would have to pay a yearly federal fee.

    Obviously, this leaves out primary care physicians. But most primary care physicians have full practices already. Where communities are divided by state lines, they may already have licenses in both states. No, what primary physicians need are CMS reimbursements for telemedicine, no matter where the patient is located within a state. Right now, a doctor is not reimbursed for a telemedicine visit if the patient is within 25 miles of a metropolitan area.  He is not reimbursed for “store and forward” of medical images, unless he practices in Hawaii and Alaska. Remove the regulations, allow reimbursements, and most primary care doctors will be interested in doing telemedicine within their areas.

    Roger Downey

    1. Telemedicine and interstate medical practicing are two very separate and distinct issues. As long as the success of Telemedicine is implied to require permission for physicians to practice across state borders, the patient will be “dead on arrival”, in my opinion.

      Interstate telemedicine is a new level of competion threatening intrastate medical practices that isn’t welcomed and won’t be anytime soon. When a physician with a Louisiana license can drive across the state border to Texas to practice without a Texas license, perhaps that will be the time for interstate telemedicine.

      The success of Telemedicine lies in the adoption of the technology by medical practices to service existing patients in more convenient ways without sacrifing the continuity of care and the inherent safety of a doctor who knows a patient well and has that patient’s record in his hands for reference when doin a vidoe conference-based consultation. That is where telemedicine needs to place their efforts in my opinion.

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