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In a recent August 2008 survey of 417 health IT professionals by the Healthcare Information and Management Systems Society (HIMSS) the overwhelming barrier to telemedicine adoption, cited by 47% of respondents (as compared to 19% for the second highest barrier of cost) was lack of reimbursement. An issue also raised in last month’s Advocate by Earl W. Ferguson, M.D., Ph.D., when he wrote about the “The Real Crisis in Our Healthcare System”, is the fact that the lack of healthcare services reimbursement when provided by telemedicine is devastating to the delivery of healthcare services in rural, underserved communities.
Once a rural healthcare facility has received funding for telemedicine equipment, and secured the technical resources for deployment and on-going support, neither simple in themselves, it appears that it could all be for naught. The reimbursement problem severely impacts their ability to secure clinical services from providers, such as teaching hospitals, technically able to connect to deliver such services via telemedicine. The rural facility’s service consumption demands will be varied, unpredictable, most likely low volume, and with a fiscally unattractive payor mix. Not an ideal match for the service provider who is looking at a fixed service portfolio, that is controlled, predictable, high-volume, and fiscally profitable. The divide seems immense.
As advocates push for a broadening and simplification of reimbursement in efforts to address a confusing, antiquated, system that favors face-to-face visits we need to look to other innovations in approach rather than resting all hope on establishment change. With a background spanning multiple industries beyond healthcare, such as manufacturing, telecommunications, and even virtual worlds in entertainment, it is my belief that we need to look for successes “outside of the healthcare box” when it comes to addressing such issues as this and others.
If we look back in time to 2000, and across industries to manufacturing, we may find a then creative solution still being applied today for the healthcare manufacturing supply chain that could represent an equally creatively solution in 2009 for telemedicine; an intermediary, in the form of an independent, consortium, or private telemedicine service exchange, who can act as a service aggregator. The basic premise would be to build service provider (e.g. teaching hospitals) to service consumer (e.g. rural facilities) connectivity that replaces the existing one-to-one relationships that we have today with a many-to-many model.
With such a “telemedicine exchange” participating service providers would have access to many service consumers. The benefits would be numerous. For the service provider it would allow efficient use of specialist time with the ability to drive to 100% utilization, it would support flexibility in payor mix to ensure profitability, and it would mitigate the risk of providing services to a single service consumer who could lose funding or in fact close their doors. With a workable model, in other words one that is profitable for the service provider, then the benefit to the service consumer becomes the simple ability to obtain services. In addition, multiple service providers working together within the exchange can provide a wider range of services, with higher availability. Ultimately, we can develop beyond predominantly scheduled service provision to an on-demand model where, for example, a rural facility that requires a neurology consult for a potential stroke patient admitted to the emergency department at 3am would be able to receive such. Economies of scale and flexibility would also drive down cost.
However, the path towards a successful telemedicine exchange has one major hurdle not present for non-clinical products and services, and interestingly brings us back to the third barrier cited in the HIMSS survey (at 17%) – regulatory limitations related to licensing and credentialing. Fortunately, the very nature of the telemedicine exchange itself, based on a centralized platform providing a transaction engine, value-added services, and collaborative functionality, could again offer the solution. The leap from managing contracts to managing licensing and credentialing relationships is not great.
Hopefully my thoughts on the concept of a telemedicine exchange spark interest in finding creative ways, in this case the suggested re-purposing and extension of an already successful technology solution, to address the major issues impacting telemedicine adoption today.
Kevin Hannah can be reached at khannah@med-rt.com
Article posted on 10/22/08 |
