Ophthalmologist and Physician-Scientist
Current Benefits and Challenges of Telemedicine

Current Benefits and Challenges of Telemedicine

Across the globe, telemedicine is helping to expand access to quality medical care while reducing costs. In 2016, more than 60 percent of American healthcare institutions were already using telemedicine, as well as up to 50 percent of all US hospitals. These figures resulted from rapid growth of the telemedicine market in early 2010. Since then, however, telemedicine has grown more slowly, partially because of the challenges that began to appear, including difficulties with reimbursements and legal issues pertaining to state licensure.

Significant Healthcare Delivery Benefits

One appeal of telemedicine is its ability to reduce healthcare costs. Telemedicine minimizes unnecessary hospital stays and visits to emergency rooms and outpatient clinics. In addition, telemedicine can help healthcare organizations of all sizes optimize the distribution of their staff. Research shows that telemedicine can improve patient engagement and thus drive better outcomes, which further reduces unnecessary use of resources. Providing telemedicine services also cuts down on the financial impact of no-shows in outpatient clinics.

Telemedicine holds promise for improving healthcare equity. People living in urban areas with limited healthcare options or in rural areas far from the nearest clinic can quickly receive medical care when they need it. Such services remains incredibly important considering 59 million Americans live in areas with a shortage of healthcare professionals, especially primary care providers. Whether they live in rural or urban areas, these people must travel greater distances for care and can experience long delays between visits, which hinders the quality of care they receive. Furthermore, it’s often impossible for these patients to see the same provider on each visit, so it can be difficult to maintain continuity of care.

Even patients living near their healthcare provider may lack reliable transportation, or they may have other physical mobility issues. In addition, some individuals are simply too ill to travel to see a physician. Some patients have compromised immune systems or other conditions that make hospital visits dangerous, because the hospital exposes them to viruses or bacterial infections. For these patients, a virtual office visit is much safer.


Issues Slowing Telemedicine Growth

Despite the clear benefits of telemedicine, current policies are slowing its broader adoption. For example, to deliver telemedicine services, physicians must be fully licensed to practice medicine in the state where their patient is physically located. This policy puts an additional burden on those physicians who want to treat patients across state lines: they must apply for multiple licenses in different states and pay the associated fees. The policy limits the effectiveness of telemedicine by limiting who physicians can treat virtually.

However, a solution may be coming. Already, several states have joined the Interstate Medical Licensure Compact, which intends to expedite the licensure process and make it easier for physicians to practice in multiple states. Twenty-nine states, the District of Columbia and the Territory of Guam participate in the agreement. The compact is a step forward, but it still requires physicians to obtain multiple licensures to provide telemedicine services.

Reimbursement problems are also preventing the broader adoption of telemedicine. Currently, only 31 states, as well as the District of Columbia, have telemedicine parity laws. These laws mandate that private insurers pay for telemedicine services, which means that in the remaining 19 states, reimbursement for telemedicine services may not be guaranteed. The specific terms of the state mandates also vary, so reimbursement rates can vary widely between states. In addition, many of largest insurers, such as Medicaid and Medicare, fall outside of the mandates. Many self-insured plans are similarly excluded, so physicians must be vigilant to be reimbursed for telemedicine services.

Other reimbursement policies are also problematic. For example, Medicare only reimburses telemedicine providers when their services are conducted at designated sites, such as skilled nursing facilities, physician offices, hospitals and rural health centers. Furthermore, Medicare only reimburses for telemedicine services in non-metropolitan areas or areas with a documented shortage of healthcare professionals. This policy excludes many patients living in urban areas who could benefit from telemedicine.

Hopeful Future of Telemedicine in the US

It’s important to remember that these problems are hurdles, not insurmountable obstacles. Policies may change in the coming years, especially as technology advances to make telemedicine even more cost-effective. New technologies are emerging every year to help physicians provide better care from a distance, including easily accessible technologies such as smartphone apps. These technologies expand the diagnostic capabilities of telemedicine and can reduce its costs even further. However, developers may lose the motivation to build new telemedicine technologies if policies do not change. Better reimbursement laws and interstate licensing processes are needed so telemedicine can reach its full potential.