Stethoscope alongside a mobile phone

DHIS19: Current and Potential Challenges of Telehealth

The idea of telehealth seems like a dream come true for patients; whenever they aren’t feeling well, instead of hopping in the car to drive to a doctor’s office, they can simply hop on their phones or computers and connect with a provider virtually. There are other benefits to telehealth as well, like healthier patients and reduced costs.

However, telehealth isn’t without its challenges, and there are many on the provider side. At DHIS19, three providers—Julie Reisetter from Ascension, Jim Sheets from Intermountain Healthcare, and Andrew Watson from UPMC—discussed their perception of telehealth in the industry today and what challenges they have encountered.  

A Lack of Telehealth Use

Despite how great telehealth solutions seem to be, the level of adoption has been lower than anticipated, both on the provider side and on the patient side. The panelists shared some thoughts on why that may be and what needs to happen in order to increase use.

“Provider adoption is twofold,” Reisetter began. “First, the solution must be embedded into the providers’ workflow, and second, providers shouldn’t be expected to log in to yet another application and link all the solutions together. There are also myths about whether providers will get reimbursed or paid for their telehealth appointments.”

Watson added, “It has taken a while for physicians to adopt other things too. Physicians see telehealth as another tech thing that they have to sign in to. We don’t need another system for patients. The question is how do we sculpt the solution so that it fits our environment with interoperability? Telehealth is there in our facilities, but it isn’t there enough. The solution has to add value.”

Sheets explained, “Of the people who have Intermountain’s health plan (SelectHealth), only a certain number have actually downloaded the app. And even fewer people are using the app’s tools.” The issue could be that patients just aren’t aware of the service or that they don’t realize the process for accessing the service.

The design of the telehealth solutions may also be inhibiting use. Reisetter commented, “We just haven’t been as thoughtful about designing the solutions for the patients.” She elaborated on the struggle to get providers to buy in as well. “But we just launched our enterprise platform, and we checked the box on the direct-to-consumer piece. We are building a product that takes into account the people it was designed for. We have great hope that that will help us drive adoption.”

Reimbursement Codes and Telehealth

Medicare coverage of telehealth was a hot topic at the American Telemedicine Association conference in 2019, and establishing the new telehealth and remote patient monitoring codes has been an ongoing process. With telehealth, getting reimbursed can sometimes be a struggle, and the panelists were asked whether they had seen anything different in regard to reimbursement codes.

Watson responded, “It’s great to have the reimbursement codes. They are proxy for change and for government awareness. But we have to be careful about this not being an additive service. Things are exciting in that area, but reimbursements aren’t what we should be paying attention to sometimes.”

Reisetter added, “People are holding back in a lot of ways because they don’t feel the reimbursements are there. Those codes are nice on the remote patient monitoring side, but I’ve also been in other organizations where the same codes are used. You may not get as many denials as you think, and if you do, then that’s a good conversation to have with your payer.”

Forming a Strategy Around Telehealth Tools

When it comes to strategizing how to use telehealth tools, some organizations stand up the tools first and strategize after the fact. It is easy to jump into exciting, new technology, but that isn’t always the best approach.

Sheets commented on his experience with Intermountain. “Our work was well-intended, but it felt like ready, fire, and then aim. Everything was completely scattered, and there was no coordination. We originally were spending 80% of our efforts on developing programs instead of expanding and growing programs that already existed.”

Intermountain flipped that on its head and stopped developing new programs while establishing a set process for adding new programs. Sheets stated, “I would never start a new program now unless there was a physician champion. When we have worked with a champion, that is when our strongest programs have taken off.”

In addition, they eliminated all their different vendors and moved to one platform to make everything less clunky. “Moving down that path slowed us down a bit,” Sheets admitted, “but now we can see where we can scale and who is asking for help. Coordinated effort is key.”

Watson suggested the best practice of working with the hospital operations and hospital finances areas. Doing so can help organizations better realize the dream of being on a single platform, or even just two platforms, since that goal is sometimes more feasible. “My advice,” said Watson, “is don’t just put telemedicine off to the side; rebuild it.”

Successes Despite the Challenges

Every system in healthcare comes with its challenges, but the panelists were eager to share some of their more recent successes. Sheets talked about teleoncology and how that has allowed his organization to connect with patients in rural areas who weren’t traveling to get the therapy that they needed. Reisetter said that her organization has pockets of services where they are doing remote patient monitoring and disease management. And Watson explained that some of the changes in his organization have decreased the mortality rate from 12% to 7% and the readmission rate by 20%–30%.

In the end, telemedicine is like any other software in that there is a learning curve as the organization figures out how to implement it, use it, and get providers to adopt it. But taking the time to prepare for the new systems and to cater to the users’ needs ultimately leads organizations down the pathway to success.




     Photo cred: Adobe Stock, Adam