ATA Fall Forum: Experts Discuss How To Overcome Barriers to Telehealth

Telehealth has the potential to solve some of health care's most persistent problems -- high costs and access to care, in particular -- but concerns about reimbursement, licensure and standards stand in the way of realizing the technology's promise, stakeholders said at the American Telemedicine Association's 2015 Fall Forum.

"It's a new solution to old problems, but we can't innovate for the sake of innovation," ATA President Reed Tuckson said. Instead, these technologies "must deliver on quality and improve cost effectiveness so as to sustain access to care that meets the needs of people around the country."

Tuckson was among several speakers at ATA's 2015 Fall Forum in Washington, D.C., who highlighted telehealth's potential to improve health care, the barriers limiting adoption and the steps necessary to overcome those hurdles.

The Potential of Telehealth

"Telemedicine is another tool in clinicians' tool boxes," Randy Schubring, director of state government relations and health policy development at the Mayo Clinic, said. "We see how it can supplement our current services."

Stakeholders noted that telehealth can:

  • Empower consumer choice and allow patients to decide how they want to receive care;
  • Expand the availability of providers in locations with physician shortages; and
  • Reduce disparities in access to care resulting from limitations in mobility and transportation.

Adam Pellegrini, vice president of digital health a Walgreen, said, "Telemedicine is a way to remove friction and make things convenient."

What's Standing in the Way?

Despite the benefits, speakers said several barriers are hindering widespread telehealth use.


"One of the biggest barriers to adoption is reimbursement," Kristin Schleiter, senior legislative attorney at the American Medical Association, said. "More physicians would use [telehealth] if they were paid for it."

There is no "widely-accepted" telehealth reimbursement standard for private payers, according to the Health Resources and Services Administration. Some insurers reimburse for a variety of services, while others have not yet developed comprehensive policies for doing so.

Meanwhile, Medicare covers certain telehealth services, such as:

  • Diabetes self-management training;
  • Remote consultations;
  • Pyschotherapy; and
  • Smoking cessation services.

But Medicare will only reimburse for telehealth services under certain conditions. For example:

  • Office visits and consultations must be provided using an interactive, two-way telecommunications system with real-time audio and video;
  • The originating site (where the patient is) must be in a Health Professional Shortage Area or in a county that is outside of any Metropolitan Statistical Area; and
  • The originating site must be a medical facility, not the patient's home.

There was a consensus among speakers that Medicare's coverage and reimbursement options for telehealth should be more flexible. They also noted that there is a need for more private coverage.

"The best thing" that the federal government can do is expand Medicare reimbursement for telehealth services, Cybil Roehrenbeck, counsel at Kilpatrick Townsend said, noting that "then private payers will follow suit."

She added that "a lot of states have reimbursement parity laws" that require private payers, and in some cases Medicaid, to reimburse for telehealth services to the same extent and in the same amount as care provided in person.

Right now, 29 states and the District of Columbia have enacted telehealth parity laws, according to ATA. Other states have legislation pending, while 13 have no telehealth parity legislative activity as of this year.

One federal bill (HR 2948), called the Medicare Telehealth Parity Act, aims for a three-phase approach to align Medicare telehealth visits with in-person services. Among other things, it would:

  • Allow Medicare reimbursement of telehealth services in rural, underserved and metro areas;
  • Expand the list of reimbursable providers to include physical therapists and speech pathologists, among others;
  • Expand telestroke services;
  • Allow for remote patient monitoring of chronic conditions, such as heart failure and diabetes; and
  • Allow Medicare beneficiaries' homes to be the site of care for some outpatient services, dialysis and hospice.

Rep. Gregg Harper (R-Miss.), who co-sponsored the bill, said that under the measure, "providers could see more patients in a day and conceivably be better compensated by seeing more patients if we get into a parity situation."

He added, "You can have the greatest tech in the world, but if you can't get reimbursed for it or paid for it, it stifles that innovation for future use."


Another common theme during the conference was trying to decide who or what entity should define the evidence-based standards of care in the telehealth sector. Speakers concluded that the lack of comprehensive standards is holding back widespread telehealth use.

Peter Antall, president and CMO at American Well, called telehealth standards the "Wild West."

"Standards are being developed, but we need more," he said. "We need more research. We need associations and academies to be more proactive."

Speakers throughout the conference offered some ideas.

Schleiter said that "many expectations don't change when practicing medicine," whether it's in person or online. That's why, she said, "medical boards have a role in setting these standards, because they protect public health through licensing and regulation and ensuring physicians comply."

Tay Kopanos, vice president of health policy and state government affairs at the American Association of Nurse Practitioners, said those conversations should happen among "clinicians, professional associations, regulators and policymakers to ensure we strike the right balance between patient protections and quality and assured access to care."

Interstate Licensure

Interstate licensure and whether physicians can provide services across state lines is another major issue as telehealth networks try to expand, Schubring said.

"In some cases, physicians have five licenses to their name. That's a major administrative burden," he said.

According to ATA, state-by-state approaches to licensure can:

  • Create economic trade barriers by "artificially protecting markets from competition"; and
  • Restrict treatment options.

Marina Lao, director of policy planning at the Federal Trade Commission, said licensure practices "ensure that only competent stakeholders are treating people."

However, she suggested that states apply an antitrust law concept "called the least restrictive alternative," which "means even when regulation is necessary, what we should try to do is choose the least restrictive means to accomplish that legitimate activity."

Source: iHealthBeat, Monday, September 21, 2015