The Critical Role Of Telehealth In The Age Of Obamacare


A Q&A with James Custer, Director, Products and Operations Telehealth, Yorktel

Telehealth video consultation sessions are in the midst of an explosion, growing from 19.7 million in 2014 to a projected 158.4 million per year by 2020, according to the latest research from market intelligence firm Tractica. To learn more about the key drivers and implications behind this trend, we sat down with James Custer, Yorktel’s Telehealth Director of Products and Operations.

How can telehealth empower healthcare providers to realize new efficiencies while improving patient care?  

James Custer: A number of companies and organizations are specializing in online scheduling in home health environments and adding encounter software to their offerings. These solutions make home healthcare more efficient.  Also, workflow analysis is improving by providing a step by step process for how the telehealth encounter should go. In the past, this feature was sometimes missing, which led to confusion and slowed down the telemedicine encounter or caused it not to happen at all.

Telehealth solutions also enable a higher level of care by making it easier for patients to get second opinions on diagnoses or procedures. Plus, telehealth opens up access to a wider choice of doctors by removing geographic restrictions.

What are the biggest myths and/or inaccurate public perceptions hindering telehealth adoption in the U.S.? 

James Custer: Three obstacles/objections to telehealth adoption include:

  1. The perception that patients won’t receive the same level of care as live visits. 
  2. Some people think doctors are less sensitive on camera and will exhibit less compassion/poorer bedside manners than in person.
  3. Fear of technology. This objection is more common among older patients who are more likely to feel uncomfortable with new methods for communicating with their health care providers.

Each of the above obstacles are based on false assumptions and can easily be overcome with facts and proper training.

What are the biggest key differentiators in videoconferencing technology that home healthcare providers and other health systems should pay closest attention to?  

James Custer: Despite overall improvements in wide area network bandwidth, there are still notable bandwidth limitations — especially in many rural areas. Some telemedicine solutions can only function properly on networks with 1 Mbps+ dedicated to voice and video traffic. Anything less causes sound or video packet loss, out of sync audio and video sessions, and an overall poor user experience. Fortunately, there are a few premiere unified communication and telemedicine solution providers that incorporate the latest data compression technology (e.g. H.264 and H.265 codec standards instead of the older H.323 standard), enabling quality voice and video communication on networks with as little as 200 kb of bandwidth.

Portability is another important topic that healthcare providers should give serious consideration to. In a hospital environment, for example, it’s often much more convenient and practical to bring a telemedicine workstation or cart to the patient rather than always bringing the patient to the workstation. Portability becomes even more important in home healthcare environment where nurses and clinicians must transport telemedicine equipment several times a day. Some telemedicine workstations weigh up to 32 lbs., which can put an unnecessary burden on healthcare providers. At the other end of the spectrum are solutions that weigh only 7 lbs., which is much more conducive to mobility without compromising audio and video quality.

What are the most prominent issues that lead to failed telehealth deployments and how can healthcare providers avoid them?  

James Custer: Failing to train staff and patients is probably the biggest issue. Expecting users to figure out all the features and functions of a telemedicine workstation is a recipe for disaster. After a few failed attempts, staff will inevitably revert back to what they know best, and it will be even harder to convince them — and the patients — of the benefits of telemedicine in the future.

In addition to training staff and patients on how these solutions work, there needs to be communication about the availability of telehealth sessions. Along these same lines, healthcare providers need to promote the convenience of telehealth and pay particular attention to older patients to ensure they feel comfortable using the technology.

Non-formalized environments are another red flag for failed telehealth deployments. In these environments, the patient is expected to know what they need and how to get the proper care. When patients are expected to figure out on their own how to incorporate telehealth options into their treatment and recovery processes, frustration with the technology and abandonment inevitably follow.

Healthcare practices that implement formal processes, on the other hand, not only ensure better care for their patients — they enjoy higher reimbursements from insurance companies. One specific provision the Affordable Care Act added to healthcare was the Hospital Readmissions Reduction Program. Starting in October 2012, the CMS (Centers for Medicare & Medicaid Services) began reducing Medicare payments for Inpatient Prospective Payment System (IPPS) hospitals with excess readmissions. Excess readmissions are measured by a ratio, by dividing a hospital’s number of “predicted” 30-day readmissions for heart attack, heart failure, pneumonia, hip/knee replacements, and COPD by the number that would be “expected,” based on an average hospital with similar patients. A ratio greater than 1 indicates excess readmissions. Telehealth is being used as a key component of hospitals’ readmission reduction programs to help combat high readmission rates.  By improving the follow-up care and care management of a range of patients — from the chronically ill to post-surgical patients ­— hospitals find they can significantly reduce readmissions.

Telehealth-related insurance reimbursement problems are another reason for telehealth deployment failures. Unlike in-person office visits that have a consistent methodology for documenting appointments and submitting invoices to insurance companies, there is wide variance in state-to-state legislation regarding telehealth reimbursement processes and procedures. For example, while Texas and California are at the forefront of reimbursement for telemedicine, some states only allow reimbursements in certain areas, situations or locations.

Why is 2016 poised to be the year of telehealth?  

James Custer: There are a couple of factors that make this a key year in the adoption of telehealth solutions and services. First, the Affordable Care Act (aka Obamacare) is now in full effect. With this new law come several specific opportunities for telemedicine. According to the American Telemedicine Association, the ACA:

  • Directs the new Center for Medicare and Medicaid Innovation (CMI), to explore as a care model how to, “Facilitate inpatient care, including intensive care, of hospitalized applicable individuals at their local hospital through the use of electronic monitoring by specialists,”
  • Allows CMI, in developing new care models, to explore whether the model utilizes technology, such as patient based remote monitoring systems to coordinate care;
  • Directs CMI to study the use of entities located in medically underserved areas and facilities of the Indian Health Service to provide telehealth services in treating behavioral health problems and stroke and to study ways to improve the capacity of non-medical providers and non-specialized medical providers to provide health services for patients with chronic conditions;
  • Requires new “accountable care organizations” to create ways to promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies;
  • Includes the use of remote monitoring for eligible medical practices in the Independence at Home Demonstration Program.

Another contributing factor is the overall increased comfort with video communication, thanks in part to the growing popularity of consumer technologies such as FaceTime, Skype, Google Hangouts, various types of social media, and other digital communications. All combined, these factors are leading to a high likelihood that 2016 will be a breakout year for telemedicine adoption.

James Custer is Director, Products and Operations Telehealth for Yorktel, the leading global provider of cloud, UC&C and video managed services.