Streamlining Telemedicine Rules a Key to Improving Healthcare Services

U.S. healthcare is immersed in a digital age where patients armed with smartphones and wearables are the consumers and efficiency is both a service and a commodity.

As access to technology expands, payers and providers alike are turning to telemedicine as a cost-effective means of delivering quality care. Patients can connect with specialists in an instant, and providers in different locations can confer on care plans in real time, improving the patient experience while reducing costs.

Standing in the path of widespread telemedicine adoption is a patchwork of state laws that dictate how services delivered via telemedicine are reimbursed. States with full or robust telemedicine parity have regulations in place that require coverage and reimbursement be comparable to in-person services.

Some states are more advanced than others. Mississippi, for example, perennially scores low on most quality care surveys, yet it is one of the most ardent supporters of telemedicine capabilities. Meanwhile, Massachusetts, a state generally known for innovative healthcare programs, ranks poorly in telemedicine due to a lack of private payer parity regulations.

While all states have some form of Medicaid telemedicine coverage, the level of parity differs when it comes to factors such as types of technologies, patient settings and tertiary care. Rules around telemedicine coverage and reimbursement vary even more widely among states when it comes to commercial payers.

Decision Resources Group tracks telemedicine parity and offers an analysis of commercial payer telemedicine parity performance by state. In addition, several states have legislation pending that would better recognize telemedicine services, and many are also making improvements to parity under their Medicaid programs.

Despite some obstacles and hiccups, telemedicine is a rapidly growing industry. The global market is expected to reach $38 billion by the year 2022. This statistic alone should provide ample incentive for the key players to make sure telemedicine reimbursement is easily attainable while restrictions are greatly minimized.

Chris Silva is a senior analyst at DRG and specializes in information technology, telehealth and big data, among other topics. Follow him on Twitter at @ChrisSilvaDRG