Approximately 130 private payers currently reimburse for telehealth services, according to a 2007 Michigan State University study. However, without state regulation each payer can determine which services are billable. Strides are being made though: 12 states have legislation requiring commercial payers to reimburse providers for telehealth services. However, while the legislation may require telehealth to be covered, it may not always stipulate that it be reimbursed at rates equal to an in-person visit. Regardless of the payment legislation, the Michigan State University study also noted the average estimate of the amount of telemedicine activity submitted to a private payer was moderate (40%), indicating a lot of telemedine transactions go unbilled.
Moreover, telehealth can be taken a step further to create another potential revenue stream for hospitals or health systems. For instance, Bloomington, Minn.–based HealthPartners, a four-hospital system with 1.4 million health plan members began an online service called Virtuwell in fall 2010 allowing anyone (with or without insurance) in Minnesota or Wisconsin to consult with a nurse practitioner for $40. Since then, some 23,000 patients have received treatment plans.
More important, says Guy, what makes telemedicine worth investing in for the hospitals "is so patients can remain in their local communities, and revenue from x-rays and other tests can remain in the community hospitals, and they are now accountable for readmissions and they need to manage patients with chronic disease or they're not going to get paid."
While in Georgia the state helped guide the development of telehealth, in Pennsylvania, Pittsburgh-based UPMC opted to expand telemedicine throughout its 20-hospital network and is now working to centralize the infrastructure to keep it cost effective.
"Our strategy is to encourage the development of telemedicine from all points of view, but centralize infrastructure to allow telemedicine to flourish. We're defining the common elements, such as IT expertise and support and legal contracting. We're developing a central platform so we can all work from a common set of technology rather than each developing separate systems and creating silos," says Lawrence Wechsler, MD, chairman of the department of neurology and vice president for telemedicine services for UPMC's physician services division.
Thirteen years ago UPMC tiptoed into telehealth using videoconferencing to offer psychiatry services to prisons. The program has grown and now has telemedicine services in 16 specialties including neurology, cardiology, pathology, dermatology, and ophthalmology and uses a variety of digital peripheries and other communications tools, such as teleconferencing and in-home monitoring. The annual volume for UPMC's telehealth consults is 13,500 visits, and it tracks another 106,000 teleradiology reads annually.