Calling on Congress -- Act Fast(er) to Remove Telemed Barriers

Posted by Michael Greiwe, MD | September 10, 2018 |
Michael Greiwe, MD

Here’s the question we’ve been pondering at OrthoLive: Can telemedicine fix what’s broken in the U.S. health system?

It may be both controversial yet stating the obvious that we’re struggling a bit in the healthcare space:

  • The Centers for Medicare & Medicaid Services (CMS) says that healthcare costs in the U.S. will increase by 5.3% each year through 2026.
  • CNN reports the average individual private insurance premium has gone up by 19% in the past five years.
  • U.S. News & World Report predicts by 2025 we’ll reach a perfect storm of Baby Boomers and provider shortages. At a time when there will be a population influx of older and sicker Americans, there won’t be enough medical providers to offer care.

We know that telemedicine can help doctors with these issues by:

  • Cutting practice overhead costs
  • Increasing patient volumes by decreasing wait times.
  • Improving access to care.

While hospitals have been using telehealth applications for years, the number of private practice physicians using telemedicine isn’t nearly as high as it could be.

Part of the problem has been that clinicians are keenly aware of some of the barriers to telehealth adoption. For telemedicine to finally deliver on its promise of reduced costs and improved access, the federal government needs to move more quickly toward supporting telemedicine by reducing some of the regulations that are holding us back. Payers need to be more aggressive in their support of telemedicine, as well, although all the major payers now reimburse for the telemedicine visit.

How can large health systems and the small independent practice, push federal and state government and insurance carriers to push forward for widespread telemedicine adoption? It’s widely acknowledged that costs need to be reduced and access improved. So, what’s the hold up here?

2016 Report to Congress

We’re not the only organization clamoring for a lifting of the regulatory barriers to widespread telemedicine adoption. In fact, a 2016 report to Congress on e-health and telemedicine suggested that our government isn’t moving nearly quickly enough to support providers adopting telemedicine in their practices.

The report was ordered by The U.S. Department of Health and Human Services (HHS) to determine the barriers to rollout of telemedicine applications around the country. Committee members delivered a blistering call to Congress to fix what was broken in order to push for faster and more widespread adoption of telehealth:

The Committee urges the Department to increase collaboration
and coordination across relevant Federal agencies on E-health and
telemedicine to assess current efforts, needs, barriers, standards,
goals, eliminate duplication and incompatibility, and ultimately
improve health quality, effectiveness, and outcomes

The committee’s report made particular note of the access to care issue in rural areas, citing that 59 million Americans now live in a Health Professional Shortage Area (HPSA). They noted these citizens have higher infant mortality rates and are more likely to use the emergency room than a primary care provider for treatment – if they can get to a hospital at all.

More startling, perhaps is the higher rate of chronic diseases in these rural communities; the report pointed out “Chronic disease accounts for approximately 75 percent of all healthcare care expenditures and contributes to about 70 percent of all deaths in this country.”

Yet the report also noted that telemedicine has a particularly impactful outcome on this population. Yet if telehealth has such a positive impact, what’s stopping the expansion of this proven and necessary service?




HHS Spells Out Regulation that Stymies Telehealth

The HHS report took Congress to task for not prioritizing “the deployment and use of telehealth modalities.” Reform is needed they suggested, including policy changes in the following areas:

  • Reimbursement
    The study noted that payment goes primarily to the consulting practitioner with a small facility fee for the originating site. The key word in this report being “small;” in 2016, Medicare was spending less than .01 percent of their budget on telehealth reimbursement.
  • Licensure
    The study suggested that the patchwork of state licensure requirements “may be inhibiting broader use of telehealth” and that “the administrative burden associated with licensure laws may nevertheless deter physicians from utilizing telehealth.”
  • Broadband Connectivity
    The recommendations also cited gaps in access to affordable broadband in rural areas. They cited data from the FCC showing 22 million Americans lack access to even minimal broadband service. The price of broadband is often three times higher in these areas than in urban regions.

The report concluded with a call-to-action to policymakers in the HHS to continue to develop legislative budget proposals designed to improve access to telemedicine, while enacting legislation to lift barriers to the service.

Signs of Light at the End of the Tunnel

“However, significant advances in telecommunications, including the improvement of high resolution imaging and greater access to broadband, have accelerated the use and availability of telehealth by a broad array of physicians and clinicians.”

Report to Congress: E-Health and Telemedicine

Office of Health Policy, Office of the Assistant Secretary for Planning and Evaluation


Fast forward two years to third quarter, 2018, and you’ll find a slight landscape shift toward loosened restrictions on telemedicine. In a prior article, we shared how restrictions tied to telehealth applications are finally beginning to weaken. For example:

  • CMS has lifted the originating site and geographic restrictions for telemedicine for hip and knee replacements.
  • More than 30 states now have parity laws, requiring payers to reimburse telemedicine at the same rate as traditional face-to-face visits.
  • The latest federal budget has loosened the purse strings for telemedicine, offering wider coverage and higher reimbursement than we’ve seen in the past.


The problem here is that we are racing the clock, as the provider shortages and high costs of care are going to converge by 2025 into a real problem for provider outcomes. So, the lifted restrictions and increasing reimbursement simply aren’t coming fast enough.

It’s clear that the “powers that be” now know that telemedicine can improve outcomes, cut cuts, and provide more patients with care, faster. Will they continue to reduce barriers to widespread of adoption of this service? Could telemedicine tip the scales toward widespread savings in a struggling healthcare paradigm? We believe telehealth offers incredible opportunities for future healthcare models. OrthoLive has democratized telemedicine by creating a reliable, affordable service designed specifically for the orthopedic practice. Let us show you how telehealth could improve your practice. Call us today.

Topics: "telemedicine", healthcare, law