Resistance from regulators, restrictive licensing rules that make it difficult for doctors to practice in multiple states, and even push-back from physicians themselves stand in the way of telemedicine. But nothing seems to be able to stop it.
Spawned by the Internet and fueled by consumer interest in self-monitoring and videocasting, telemedicine—a broad term that covers a range of services including virtual visits and remote monitoring—is growing, despite some stubborn obstacles.
In Austin, MN, employees of the local school system can step into a booth at work, shut the door, and consult a doctor via video. Inside, the booth, they can put on blood pressure cuffs and instantaneously send the results to the Mayo Clinic, 40 miles away.
In Ohio, Cleveland Clinic is offering $49 virtual visits to patients who have an Internet connection and a video-enabled device. And University of Iowa Health Care just launched a telemedicine program last month.
Providers and retailers are racing to enter the space. Walgreens now offers $49 video visits via an app and a website. And companies like NowClinic and American Well are popping up to compete with established providers like Mayo Clinic.
Joseph Kvedar, MD
Joseph Kvedar, MD, vice president of the Partners' Center for Connected Health in Boston, says that at two recent health industry meetings "every panel and every conversation had something on telemedicine and virtual visits."
Telemedicine is taking off, but there is resistance from regulators in at least one state, and stubborn questions about reimbursement and efficacy in general.
One telemedicine provider, TelaDoc, is engaged in an ongoing legal battle with the Texas Medical Board, which wants to restrict video visits to follow-up care or doctor-to-doctor consults. Essentially, patients would have to see a doctor face-to-face first before interacting via video. In May, a federal judge blocked enactment of the rule until after the case goes to trial.
But, earlier this month, doctors from Texas convinced the American Medical Association to table a proposal for telemedicine ethics guidelines. The plan would have allowed virtual visits without a face-to-face encounter.
Who Will Pay?
Another barrier, says Kvedar, is reimbursement. He notes that the Centers for Medicare & Medicaid Services published a new chronic care management code in January that will allow physicians to bill for consulting patients via video.
UnitedHealthcare, the country's largest commercial payer said last month that it will offer coverage for virtual doctor visits to 20 million beneficiaries by next year. Anthem offers its own version of telemedicine.
For hospitals, the approach requires a strong relationship with primary care physicians and a solid electronic health records system, Kvedar says.