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Assessing Telehealth’s Value

A typical value-based care contract (VBC) is extremely complicated, but gauging the overall value something brings is much easier – and telehealth delivers amazing value.

Recently, at the American Association of Nurse Practitioners’ Specialty & Leadership Conference, family nurse practitioner Thanh Nguyen from Providence Health Express in Oregon noted that “we don’t know” what telehealth’s return on investment will be in the new value-based care model. Only about 40% of providers are even using VBC contracts, which means that six out of 10 providers are still using the fee-for-service approach.

But Nguyen is certain about one thing: telehealth is providing undeniable value every day. In her view, it’s saving lives and improving access to care while offering growth opportunities for nurse practitioners.

Nguyen feels that it’s now time for legislators and regulators to bring more telehealth value to clinicians – namely, getting paid for every hour worked.

In a recent speech, the American Medical Association’s immediate past president, Dr. Steven Stack, spoke about the need for a “quadruple aim”: adding “clinician satisfaction” to the current trio of improved access, better care and lower costs. “We need to restore joy to the practice of medicine,” he said – one way to do that is fair compensation for the long hours worked.

Current reimbursement policies don’t allow telehealth providers, like Nguyen, to get paid a penny for the time it takes to respond to patients’ emails. She’s licensed to practice only in Oregon and Washington, and she recently got burned by a Nevada patient who claimed to be visiting friends in Oregon. Ultimately, Nguyen had to waive her fee for the 20-minute session.

The healthcare industry’s journey to value-based care is a worthy effort, but it will only succeed when it brings real value to the clinicians who make it happen – and when it fairly compensates them for the care they provide via telehealth technology.

Taking the Longer View

It’s very easy to be on the wrong side of history. When IBM dismissed the personal computer as a passing fad, it lost its chance to be an enduring player in that market. And the same is true for physician organizations that take a short-term view of telemedicine’s transformative power.

Case in point: the Florida Medical Association staunchly opposes the Florida Telemedicine Act, a proposed bill that would allow physicians licensed in other states to treat Florida patients via telemedicine. In fact, the FMA recently conducted a statewide patient survey to try to bolster its position.

More than half of the 600 patients surveyed were “strongly opposed” to letting out-of-state physicians treat them. But it’s highly unlikely that any of those patients have had a life-saving encounter with a remote physician. If you were to survey stroke patients in rural Idaho who have been administered tPA by a physician thousands of miles away, you’d get a much different story.

The FMA is obviously taking the myopic stance that physicians in Boston or Chicago might take business away from Florida doctors – or might deliver inferior care. That’s absurd, of course, and it overlooks telemedicine’s long-range potential.

The FMA’s line-in-the-sand opposition reminds us of the roadblocks faced by early proponents of laparoscopic surgery, which is now a worldwide standard of care. One of the pioneers in that field, Dr. Erich Mühe, was nearly hounded out of the medical profession in the 1980s.

Like Dr. Mühe, telemedicine advocates are on the right side of history, even though they’re facing many obstacles at the moment. Twenty years from now, medical students will scratch their heads and wonder why telemedicine had its critics in 2014. Some breakthroughs – like personal computers, laparoscopic surgery, and telemedicine – are too pivotal and important to resist.

Time To Blitz Your Board

As you might expect, American Telemedicine Association CEO Jon Linkous has many insights on telemedicine’s biggest challenges and its winning strategies. This blog will examine one of the challenges, and next week we’ll look at the unlikely allies who are helping advance the cause of telemedicine.

When we spoke to Jon recently, he felt that poorly informed state medical boards constitute telemedicine’s biggest hurdle at the moment. They’re still basically clueless about many aspects of telemedicine, and that’s why the rules concerning multi-state licensure are still in the Stone Age.

But Linkous rightly maintains that medical board bureaucrats (like all bureaucrats) can eventually change their minds if they get the proper education and persuasion. The key here is consistent, ongoing outreach to medical boards – and we all have a role to play.

Be an advocate for telemedicine at your state’s next medical board public meeting.

Every state medical board (and some states have more than one) hosts a monthly meeting open to the public – with schedules released far in advance. So it’s quite easy for telemedicine advocates to get on the agenda in their respective states. Like Woody Allen once said, “Ninety percent of success is just showing up.”

It’s really that simple. First, find out what your state board’s telemedicine policies are by clicking on this link: http://www.fsmb.org/pdf/grpol_telemedicine_licensure.pdf

Then use the link below to find the address and meeting schedule for your state board:

http://www.fsmb.org/directory_smb.html

Many of the board officials know less about bandwidth than your teenagers, so be patient. You may encounter people who think that if Hippocrates didn’t need telemedicine, neither should we. But don’t forget that many modern legislative miracles – like the Americans with Disabilities Act – were the result of many years of persistent plugging and nonstop education.

We all need to double-down in our efforts to educate state medical boards. This is one battle that can’t be won by giving it a “tele” prefix. You must be present to win.