E-Patient Update:  The Impact Of Telehealth Confusion

Posted on January 27, 2017 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

I am a huge fan of telemedicine consults. As far as I can tell, all of the chronic conditions I currently cope with can be addressed effectively by a virtual visit unless I’m in a medical crisis.

My reasons are not unusual. Like most people, I hate having to drive to a doctor’s office if I’m already feeling yucky, particularly if it’s not necessary. And since time is money – particularly when you work for yourself like me – there’s some material benefits to telehealth too. Not only that, since I’m a tech fan who lives online, these contacts “feel” as real as face-to-face visits, so I don’t have lingering doubts that I’m not getting much for my money.

Getting a quick visit in regarding an acute medical issue (like, say, a sinus infection) has been pretty easy and relatively affordable as well. But reaching out to a new specialist – or even connecting with my existing providers — is another story. Over the last several months, I’ve encountered a number of barriers which seem to be fairly entrenched in the system.

Garbage contact info

Over the last year, I’ve been with two major health insurers (CIGNA and United Healthcare) whose databases included a list of specialists which were allegedly willing to do telehealth consults. But as it turns out, actually moving ahead with such visits has been impossible.

At one point, I decided to go all out and see if I could actually schedule a telehealth visit with one type of specialist I need. Armed with a list of providers who were supposedly up for it, I called perhaps 15 or 20 offices to see how I could schedule my first virtual visit. But I got nowhere. Most of the physicians simply never returned my calls, and in the rare cases where I got a live person, they had no idea what I was talking about.

I’m assuming that this happened because the doctors had the option to check a “telemedicine” box if they were generally interested in implementing it, and that few if any had actually gone ahead with their plans. But I’m still very annoyed with the whole thing. Sure, insurers don’t have perfect information on hand at any given moment, but isn’t in their interests to steer patients to less-expensive telehealth services if they’re available?

Coverage confusion

Another thing that astonishes me is that while I allegedly have telemedicine coverage via my current insurer (CIGNA) I can’t find anyone who has the slightest idea of how I should use it!  I have called CIGNA’s call center four or five times in an attempt to straighten this out, but none of the reps I spoke with had a clue as to which providers were covered by my policy, if any, and under what circumstances.

At some point, telemedicine coverage will be known as “coverage,” of course. There’s really no reason to segment it out into a separate category if you’re going to pay for it anyway. But at present, if CIGNA is any indication, there’s still some confusion around how and when coverage is even applicable. I can’t understand it, but I can attest to you that such foolishness is a Real Thing.

Launch fears

The other problem I’ve encountered is that while medical practices may have the technical capability to deploy telemedicine, they seem afraid to do so. I’ve asked many of my doctors (and their staff) what it will take for them to begin offering virtual visits, and I’ve gotten a mix of confusion and concern. None, even for example the fairly large and seemingly well-funded PCP office I visit, appears to be anywhere close to rolling out such services.

I can’t prove it, but my sense is that two things are going on here. First, I sense that practice leaders don’t feel ready to take on the technical challenges involved in supporting virtual visits. Though my guess is that security is the only real issue — which can be addressed by using the right vendor — they seem quite timid about even experimenting with this approach. Second, I am pretty sure they’re not sure how to handle billing, or alternatively, what to charge if they don’t bill insurance.

I admit their concerns are reality-based. But I’d argue that the benefits of offering telehealth far outweigh these concerns. Apparently, my doctors don’t agree just yet.

Ultimately, I think we’d all agree that telemedicine uptake will grow by leaps and bounds over the next several years. But it seems we’ll have to deal with a lot of administrivia before that can happen.