Telemedicine is not a new technology.
In fact, we’ve been doing telemedicine for almost 20 years at ClickCare. As you may know, we started by pioneering in a School-Based Health program at local underserved elementary schools. That program used newer technology — including some digital cameras — but really, the success of it was related to the approach and openness of the providers, patients, and families involved.
Because the school nurses and the pediatricians were so oriented towards caring for their young patients as well and as holistically as possible, they were open to trying new approaches. As participants saw the success of the program, it became broader and more organizationally supported. And honestly, at no point was there any conversation around reimbursement or policy — it was just one more way they cared for their patients.
All of the providers that use iClickCare today approach it similarly. While telemedicine is increasingly common, it’s certainly not the default. And so providers or hospitals that incorporate the tool do so as a conscious choice. Reimbursement improves; political and organizational support expands; but through it all, providers carry on with the tools and approaches they think will help their patients the most.
I was interested to read a report in JAMA, however, and extended in Fierce Healthcare, looking at how telemedicine use is expanding (or, in some cases, not), and how reimbursement laws relate to these adoption phenomena. Parity laws demand that insurer reimbursement be the same for telemedicine-based care as for in-person care. These laws have been adopted in 64% of US states. In confluence with this, there was a significant uptick in telemedicine usage among primary care physicians between 2015 and 2017. For more rural areas, mental health services seemed to be higher usage than other specialities. While in urban areas, primary care telehealth was more common.
This is all in line with the expansion of both telemedicine and reimbursement that we’ve seen. Parity laws demand that insurer reimbursement be the same for telemedicine-based care as for in-person care. That said, one interesting fact stood out: “the data showed a negative association with states that enacted comprehensive parity laws mandating reimbursement for the services.” Perhaps that is because those states struggled the most with adoption in the first place — but either way, it’s clear that adoption “from the grassroots” may be more effective than approaches that aim to implement telemedicine starting at the policy level.
With any shift in practice, there is always a combination of technological, personal, psychological, and societal factors that need to come together for the technology to be incorporated into use.
For instance, simply inventing the telephone doesn’t create a culture that calls your friends. A combination of phone lines, social change, and early adopters combine with the new invention to lead to a society that talks on the phone.
On the one hand, telemedicine is becoming increasingly widespread, generally. There is increasing consensus that telemedicine can contain costs, increase access, and cut healthcare provider burnout. It’s not surprising that so many providers, patients, and payers are incorporating the technology into how they “do medicine.” On the other hand, telemedicine implementation isn’t a matter of policy or a “snap of the fingers.”
Ultimately, telemedicine adoption must come from providers and patients. There is no way to legislate or demand creative ways of caring for our patients.
Learn more about how to implement telemedicine in your organization, economically and quickly, with our Quick Guide to Hybrid Store-and-Forward Telemedicine: