by Katherine Restrepo
Director of Health Care Policy, John Locke Foundation
Since the late 1800s, telemedicine has had far reaching effects on patient care. The invention of the telephone allowed for physicians to begin resolving patient consults at a distance, saving them from making unnecessary house visits. Fast forward one hundred twenty years, and this isn’t too different from how telemedicine companies that offer virtual physician encounters operate. Other technological advancements have helped expand the scope of telemedicine even further so that teams of providers located in different areas can now coordinate treatment for some of the most complex medical needs.
For the convenience that telemedicine offers without compromising the quality of care, some medical providers are still resistant to adopting the practice because certain services don’t always come with insurance reimbursement. Such pushback is one of the reasons why 32 state legislatures have passed parity laws or statutes that force private insurance carriers to cover treatment via telemedicine that otherwise is reimbursed during an in-office visit.
North Carolina’s legislature has not enacted a telemedicine parity law, but it did pass a law that directs the Department of Health and Human Services (DHHS) to assess the telemedicine landscape in other states and recommend policies for lawmakers to consider. One of those policies listed is “private payer telemedicine reimbursement standards.”
It’s admirable that the General Assembly wants to advance legislation that has the potential to encourage more medical professionals to adopt telemedicine so patients can access health care without having to travel long distances. However, it’s a false notion to think that a state is behind the times with telemedicine if it does not enforce parity laws. North Carolina, one of the remaining non-parity states, is in fact engaged in many telemedicine initiatives that span multiple levels of care.
Virtual Physician Visits
I’ve written before about the homegrown startup RelyMD and how its board-certified emergency physicians connect with patients through phone, computer, or tablet to address non-urgent acute incidents – all for a $50 flat fee. Interestingly enough, RelyMD doesn’t depend on building its customer base through private insurance carrier contracts. The company has instead expanded through partnerships with community health centers and more than 70 corporate clients statewide.
That’s not to say that insurers don’t value virtual visits. Even without parity laws, most major private carriers are offering these services to their policyholders through either an in-house platform or other vendors. And those that do not cover virtual visits should not be coerced by the state to do so. Competitors may choose instead to invest in other health benefits that are perceived to be more cost effective. That’s the beauty of the market. Let insurers compete to the extent that they can, despite their consolidating over the years.
Carolinas HealthCare System ICU Remote Patient Monitoring
Large hospital systems like Carolinas HealthCare System (CHS) have made some serious telemedicine investments within their intensive care units (ICUs). The ongoing intensivist shortage combined with the difficulty of recruiting specialists to work in rural hospitals compelled CHS to build a $12 million virtual care center in 2013. Located outside of Charlotte, the command center is staffed with intensivists and nurses who are responsible for remotely monitoring hundreds of patients’ vital signs and labs across ten ICUs.
Given that ICUs now make up 30 percent of a hospital’s cost, largely because they care for the sickest patients and a rising number of baby boomers, the command center’s additional layer of oversight has begun to pay dividends for CHS. The ability for remote providers to practice proactive medicine has helped lower the health system’s mortality rates by 5 percent and length of stay by 6 percent. Faster discharge rates also open beds within CHS’s rural hospitals to make room for higher volumes of patients. Perhaps what’s most important is that patients who are admitted to one of CHS’s rural ICUs can stay closer to home. In the absence of the command center’s extra sets of eyes and ears, they would otherwise be transported longer distances to CHS’s hub hospital to access a critical care specialist.
University of North Carolina Health System ICU Partnership With Mercy Virtual
Another initiative established last year is the tele-ICU network between University of North Carolina Health Care System and Mercy Virtual, a $52 million “hospital without beds” located in Missouri. The hospital’s mission is to remotely deliver health care for patients in various settings. Within its multi-facility network, Mercy assists patients in the comfort of their own homes to avoid readmission penalties and unnecessary emergency room visits, to assess stroke victims at a distance, and to respond to provider teams at other ICUs. North Carolina Health Care System’s partnership is significant in that it represents the first major hospital “spoke” outside of Mercy Virtual to connect to the “hub.” Mercy currently monitors 28 North Carolina ICU beds.
Whether third-party payers reimburse for remote patient services, Mercy chose to invest in this program to prepare for the continual shift to risk-based contracts, that is, when a health system is rewarded or penalized based on cost savings and patient health outcomes. Its tele-ICU program has already achieved significant declines in patient mortality and length of stay, generating savings upwards of $50 million.
In sum, telemedicine parity laws are really just a type of health benefit mandate. The state should instead continue legislating with good governance, as it has done, by removing licensure barriers so telemedicine can reach even more people. During the previous long session, Governor Roy Cooper signed off on pivotal legislation that permits nurses to obtain a single, multi-state license so they can deliver telehealth to out-of-state patients. Legislators should also consider making North Carolina part of The Interstate Medical Licensure Compact, sponsored by the Federation of State Medical Boards (FSMB). Through this compact, physicians can become licensed to practice medicine (inclusive of telehealth) in surrounding states.