Hedging your telehealth bet in 2021
In 2020, we’ve all had our share of guesswork. We have all had to think about what used to be normal and commonplace and how we must think about things moving forward. Work? School? Social life? Check, check and check.
Outside of “expect the unexpected”, there was another thing that cemented itself in our lives last year and that is telemedicine and telehealth platforms. Once considered to be a nice to have, telemedicine has now become not only technically accepted but the regulatory and reimbursement hurdles have been largely cleared and even the rules around having to ensure that patients and providers use HIPAA compliant telehealth platforms for telehealth delivery have been relaxed.
Relaxed Regulatory and Reimbursement Rules
The Centers for Medicare & Medicaid Services (CMS) changed their payment policies to reimburse for a much wider range of telehealth visits and even some Health Insurance Portability and Accountability Act (HIPAA) technology security regulations were temporarily loosened to make it easier for doctors to communicate with their patients through whatever devices they had access to. Before the public health emergency, telehealth would only be reimbursed by Medicare for limited situations, such as providing service from centers of excellence out to patients living in rural areas who have little to no access to care. The relaxing of the communication security requirements which stipulated that patients can only use HIPAA-compliant telehealth platforms, opened up the ability to use smartphones to make these encounters happen and increased consumer convenience and technical acceptance. Most private payers also followed Medicare’s lead and changed their reimbursement policies.
As things return to “normal”, how do we incorporate things from the “new normal” into the “old normal”?
As it relates to telehealth, we can take a mix of the former healthcare delivery method and the new reality to come up with an approach that encompasses a hybrid version of how healthcare is to be delivered from here on out in a post-COVID world.
In 2021- More Choice For Everyone
The projections of how telehealth solutions will be consumed are all over the map. Some providers have made the decision to see patients via telehealth video conferencing whenever possible. Conversely, some patients want to only see their providers this way because they love the convenience of not having to worry about transportation or the risk of a hospital-acquired infection. While the majority of people would love for things to go back to normal, that is unlikely to happen. So where do we go from here?
As a provider, at the beginning of the pandemic, appointment cancellations were piling up and the idea of paying such a high cost for a brick and mortar facility only to have nobody come to it was a very scary reality that pushed some healthcare practices to the brink. As telehealth solutions gained in popularity as a result, the only answer was to pay for an “all you can eat” telemedicine plan because there was no other alternative consumption model. These types of plans can be costly, especially when providers don’t really know how much they’re going to use them.
Looking Into The Crystal Ball
When we come out of this, we know telemedicine will play a bigger role in care delivery than pre-COVID but how much of a role will be determined by patients, public and private payers as well as regulatory bodies. There is a persistent concern within CMS local and national circles that if you make telehealth too convenient, you will have program cost overruns due to too many unnecessary consults. Many Medicare and medicaid programs overestimated the cost of this paradigm shift and thankfully in places like North Carolina (as one example out of many), they didn’t run into a budget shortfall due to the unprecedented uptick in telemedicine visits. As a matter of fact, all major metrics regarding telehealth and COVID that were being tracked trended positively, including patient outcomes, patient satisfaction and utilization.
Is anyone recommending that providers completely shutter their brick and mortar practices in favor of telemedicine? Of course not. Will some of them do just that? Yes and some already have.
Will things ever go back to the old normal? Of course not. Will there be a middle of the road approach to telehealth? That’s what I’m betting on and for the benefit of all involved (patients, providers and payers), a model that is based on a mix between the old and the new seems most sensible.
For providers, a possible way to hedge your telemedicine bet may be to pay low monthly costs in a “pay by the drink” model. This could help to ensure that you monetize your telehealth solution spend every time you use it. You only pay for what you use and the cost of the telehealth platform simply becomes part of the cost of goods sold in running a telehealth practice. This is whether or not you end up what you have planned for. As those projections are hardly ever precisely right, you will have the flexibility to use more or less as you figure out over time what your telehealth solutions usage will actually be.