With 15 states now requiring insurers to cover electronic medical consultations and treatments, telemedicine is not so much an emerging trend as one that has arrived.
What began as a way for patients far from specialized care to connect with a doctor, is evolving into an increasingly popular way for workers to avoid taking time off for minor illnesses. While tech giants provide onsite clinics and doctors for their workers, telemedicine allows even SMB employers to provide a similar, if not identical, service for their workers.
In Hospitals and Health Networks Most Wired 2011 survey, 27 percent of physician offices and 42 percent of hospitals reported offering some kind of telemedicine service. Those percentages are even higher today, as insurers expand their coverage — whether because they must by law or, as Blue Cross/Blue Shield did in North Dakota a decade ago, because it is cost-effective.
Large employer offering telemedicine services
Employers are beginning to insist on coverage of teleconference consults, as well as for the medical equipment that is sometimes needed to remotely monitor certain types of patients — cardiac cases, for instance — who might otherwise be hospitalized for monitoring.
Some of the largest employers who have their own health centers are adding or will soon offer telemedicine services. A Towers Watson survey of onsite health centers this year said 28 percent of employers will offer telemedicine benefits by the end of next year, up from 8 percent now.
Notes the report:
In addition to onsite centers, organizations are looking to telemedicine as another way to reduce time spent in doctors’ offices and delays in securing appointments. The decrease in travel and wait times associated with visits to primary care physicians can have a direct impact on employee productivity. It reduces time away from the work site as well as time lost at the work site due to worries about a health condition or making appointments. Telemedicine is being used both on a stand-alone basis and as a complement to onsite services.”
Some employers are opting to offer a supplemental type of telehealth service. Often an adjunct to an employer health plan, these programs enable workers who opt in to have access to a doctor 24/7. Most of these supplemental programs offer direct physician consults, including diagnosis and prescriptions, but only for a limited number of conditions. Outside these, patients are directed either to their local doctor or, in serious cases, to an emergency room.
“This model works because you can be seen when you want as quickly as you want,” said Dr. Alan Roga, speaking at a Benefits Forum & Expo last month. The CEO of STAT Doctors, Roga called telehealth benefits a great “turn-key solution for the employer.”
Employees generally cover the costs
Some of these programs are fully paid by the employers. In more cases, the employee covers the cost of participation themselves. They are also open to consumers, generally.
Consult A Doctor started as a direct to consumer service, but began offering the telephone consultation service through employers a few years ago. It may seem redundant to have both a traditional health plan and a telemedicine program. However, companies that provide both, say the benefit of the latter is that it provides immediate access to a doctor who can prescribe medication, which cuts down on absenteeism and missed time while employees wait to see their regular physician.
Robert Reers, Northeast regional benefit practice leader for USI Insurance Services, says the company began offering the Consult A Doctor service a year ago. “We saw a need for our clients in terms of access to primary care physicians,” he says. “We look at it from a productivity and absenteeism standpoint as well as being able to provide employees with greater access to care.”
Rent-A-Center, a nationwide furniture rental company, began offering a telehealth service from Teladoc Inc. last year and so far, has saved almost $800,000 in direct health costs and lost productivity.
A tangle of licensing laws and rules
Like all health benefits, these standalone supplements have ERISA implications, and may also has consequences for employees with Health Savings Accounts. Reers, of USI, says his company involves compliance attorneys to review the programs employers want.
One of the other curbs on the growth of telemedicine is the tangle of licensing laws and rules regulating the practice of medicine. The Federation of State Medical Boards has a “Telemedicine Overview” posted on its site, which lists the rules by state regulating the practice. The overview is 18 pages long.
Frustrated by the regulatory web, the American Telemedicine Association last year launched FixLicensure.org, to reform U.S. medical licensing as it relates to providing medical services in other than face-to-face settings in the same state where the doctor or other practitioner is licensed.
Medicare is less progressive when it comes to home health care via teleconferencing or other electronic systems. Professionals will be reimbursed for consultations and medical services, including psychotherapy, but only to patients is approved facilities. Home services are not yet covered, except for some limited types of monitoring services.