Telehealth in Respiratory Care

Reducing the cost of healthcare services without decreasing the quality.

By Michael L. Smith, JD, RRT

Reducing the cost of healthcare services without decreasing the quality of those services is a universal goal of all the stakeholders in healthcare. Telehealth is almost universally accepted as a means to reduce costs and still provide quality care. However, telehealth still faces significant impediments to its implementation due to inconsistent reimbursement and limitations imposed upon the delivery of telehealth services.

Telehealth is the provision of healthcare services by the exchange of medical information from one site to another site through the use of electronic and telecommunications technologies. Telehealth is not the provision of healthcare services through an audio only telephone, email message, text message, facsimile transmission, mail or parcel service, or any combination of those means.

Telehealth provides numerous benefits for patients and providers in addition to reduced costs. Telehealth can provide better access to healthcare for patients in rural areas. Telehealth can improve patient care by providing patients access to specialists and specialized treatment. Telehealth can improve patient outcomes by providing followup care and preventive care.

Despite the benefits, there are also some impediments to the widespread implementation of telehealth. The cost of the technology necessary to implement telehealth, and the compatibility between different technologies is still a factor for some providers. Practice across state lines is also an impediment to telehealth. Generally, a physician or other practitioner must be licensed in the state where the patient is receiving health care services including telehealth services so practice across state lines, even in adjacent states, may be difficult.

Telehealth in Respiratory CareThe limits on reimbursement, or a complete lack of reimbursement, for telehealth services has limited its implementation. Medicare and other third-party payers that do reimburse for telehealth impose severe limitations on what services may be provided. Medicare will cover some telehealth services, but only for patients located in Health Professional Shortage Areas, or when the patient is located in specific rural areas. Medicare also requires that the patient be located in medical facility which is defined as a doctor's office, a hospital, a critical access hospital, a rural health clinic, a federally qualified health center, a hospital-based dialysis facility, a skilled nursing facility, or a community mental health center. Medicare will not pay for telehealth services provided in the home.

The provision of telehealth services raises other legal issues for physicians and other providers. For example, the scope of practice for telehealth providers may be different across state lines. The telehealth practitioner needs to know the specific scope of practice for a similar practitioner where the patient is located. The telehealth provider also needs to maintain adequate medical records based upon the requirements where the patient is located, and also maintain the confidentiality of those records based upon the patient's location. The telehealth provider must also ensure the confidentiality of the electronic health information exchanged between the patient and the provider.

Recent studies have examined the benefits of telehealth for home ventilator patients and found significant cost saving through the use of telehealth. Most home ventilator patients have numerous other medical conditions that require management. The cost of transporting a home ventilator patient to a hospital to manage even a minor condition can be astronomical. According to one study, a hospital admission to manage a relatively minor condition of a home ventilator patient could easily exceed $80,000.

Telehealth is a viable means to improve patient care and reduce health care costs when used appropriately. While originally considered only a means to provide very basic care, telehealth is proving useful in numerous care settings, including with home ventilator patients. The cost savings of using telehealth in the care of home ventilator patients appear to be considerable based upon the limited studies to date.

Michael L. Smith is board certified in health law by The Florida Bar and practices at The Health Law Firm in Altamonte Springs, Fla. This article is for general information only and is not a substitute for formal legal advice.
 
 
This article was originally published in: Advance for Respiratory Care and Sleep Medicine.