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Paying for telemedicine? Forget reimbursements, panelists say, and get creative

By Eric Wicklund, Editor, ATA 2012 Show Dailies

SAN JOSE, CA – The four participants in Monday's "Paying for Telemedicine" industry executive panel discussion agreed very quickly on one key fact: Forget, for now, about reimbursements.

Once you get beyond expecting the government to pay you back for your services, they said, you can get creative and find new sources of ROI.

"You need to rethink the value proposition," said Roy Schoenberg, MD, CEO of American Well, and "look at all the (other) pieces of the puzzle," like payers and patients. He said the traditional concept of thinking solely about how physicians will be paid is too shortsighted.

"There are models and innovative ways," added Kathleen Plath, vice president of sales and marketing for Specialists on Call, "so that we don't have to wait for reimbursement."

Moderated by Cardiocom CEO and President Daniel L. Consentino and featuring Schoenberg, Plath and Randall Swanson, vice president of business operations for Intel GE Care Innovations, the panel discussion, held in a packed conference hall during the first full day of ATA 2012, tackled what many consider to be the chief barrier to full-on acceptance of telemedicine as a standard of care. And the panelists generally agreed that, instead of waiting for the government to embrace and reimburse for telemedicine, providers need to look for other sources of value.

"Where is telehealth generating value that people are willing to pay for?" asked Schoenberg.

For instance, he said, health plans might be willing to pay to help their members stay healthy and avoid unnecessary hospital visits, patients themselves might be willing to pay if it helps them avoid much more expensive healthcare encounters down the road, and employers – both large and small – might be willing to pay to ensure their workforce is healthy and productive and isn't taking time off from work to visit the doctor or nurse a cold.

"Self-insured employers … have a big interest in controlling the exploding growth of healthcare costs in their space," said Swanson.

Schoenberg said the development of accountable care organizations (there are some 150 proposals before the Centers for Medicare & Medicaid Services, said Consentino) will spur telemedicine because they require payers and providers to assume a portion of the risk in preventing avoidable health problems, and "risk is a great thing because it forces people to think about innovation."

"It's not cookbook medicine any more," Swanson said.

On the other hand, Schoenberg said, ignorance is one of the bigger barriers to telemedicine adoption. As an example, he pointed out a recent bill before California's legislature that was designed to curb illegal use of online pharmacies, but was worded to basically eliminate telemedicine in the state.

"One of the biggest obstacles is we don't know what we don't know," added Plath.

The panelists generally agreed that telemedicine will continue to grow, regardless of whether the Obama Administration's healthcare reform efforts are overturned by the Supreme Court or how long it takes for reimbursement to catch up. Consentino then pointed out that it's taken 20 years for telemedicine to get this far, and most of that growth has been seen in just the last couple of years.

"We need to build an evidence base that shows and demonstrates a clear value proposition," he said.

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