But the extension of care into the home – often characterized as telemedicine – is a blip on the screen in comparison to the scale of efforts underway in other aspects of telehealth, where health care organizations are cutting costs and improving care through electronic data record sharing, telepresence-capable connectivity between major hospitals and remote facilities, use of specialized machinery to support remote diagnostics and much else.
The economics and potential care benefits of telemedicine are as significant and almost as widely documented as they are for the other categories of telehealth. Executives at telephone and cable companies we’ve talked to who are spearheading pursuit of business in the telehealth vertical invariably attest to the importance of factoring telemedicine into the whole telehealth benefits equation. Growing numbers of health care organizations, including especially the new Accountable Care Organizations (ACOs) whose financial models are built on fixed payment structures that make cost savings a fundamental part of the business model, are looking for ways to leverage telemedicine.
But there are big barriers to making residential telemedicine services a significant component of telehealth, starting with the fact that there is no legal framework for creating reimbursement incentives comparable to the incentives that have been legislated for electronic data records, reduced hospital admissions and other telehealth benefits under the Medicare and Medicaid laws, the Affordable Care Act and other federal and state laws. In a recent study conducted by the Center for Connected Health Policy, an independent not-for-profit based in Sacramento, Calif., researchers found minimal support for telehealth at the state level with little consistency among legal frameworks for reimbursements and other aspects of remote care.
At the federal level there appears to be just one initiative bearing on the broad range of telemedicine issues, the Telehealth Promotion Act introduced at the end of 2012 by Rep. Mike Thompson (D-Calif.), which would allow physicians to practice telehealth across state lines and expand federal reimbursement for telehealth services such as remote monitoring. Little has been said about the legislation since it was introduced, but it does shed light on an opportunity for service provider lobbyists to use their clout to promote such legislation.
Indeed, says Satyanarayana Parimi, vice president of product management and vertical markets at Time Warner Cable Business Class, lobbying on telehealth has now become part of the company’s efforts to expand its business in this vertical. “We’re working with our lobbyists in Washington D.C. and the states to promote legislation that would allow telemedicine to be more reimbursable,” Parimi says. “We need our legislators to make it easy to bring services to market with better regulations for devices, rules for remote prescriptions and other things as well as reimbursement incentives.”
So far, telemedicine has largely been about trials – “trials ad nauseam,” as Parimi puts it. “What we’re trying to do is prove out the fact we can deliver telemedicine services at a large scale. We’re not interested in offering solutions that work with a few hundreds. We’re interested in providing services to tens of thousands.”
As Parimi notes, a video service provider like Time Warner Cable is especially well positioned to make telemedicine a mass market opportunity, given the fact that so many of the people who would benefit from telemedicine, including the elderly, chronic care patients and people in transition from major surgery and other types of hospital care, often don’t have PCs. But virtually all have TV sets.
“Our strength in providing residential telemedicine services ties back to our core competencies,” Parimi says. Along with a local presence – “feet on the street and operational reach” – the emergence of digital interactive TV service and VOD has created an opportunity to leverage the TV to interface with health monitoring devices and provide video conferencing in support of virtual physician visits.
“We’ve done trials with PCs and even standalone devices,” he says. “They’ve been successful from a technology perspective, but the people we’re targeting often aren’t tech savvy enough to use the services. Now we’re switching more to TV-based solutions where the [equipment] price points are attractive and we can deliver the services to a large group of people.”
But the TV introduces still another level of uncertainty that needs to be addressed by clear regulations. “When we ask about reimbursement, we’re hearing from a number of places that maybe reimbursements for television-based service may not be palatable because of concerns about abuse, questions about how to track usage, what the reimbursement model should be, etc.,” Parimi says.
However, his group is getting traction with the ACOs. “They’re very interested in telemedicine,” he says. “We’re seeing a lot of excitement and energy around this.”
A big lobbying push to get the rules straightened out could net huge results for service providers. Not to mention for the health care system at large.