By 2018, the telehealth services field will likely attract 7 million patient users, quite a jump from the 350,000 in 2013, according to an IHS Markit report. But with telehealth expansion comes a slew of regulatory and legal challenges.
"We are tracking state laws as they change, medical boards, pharmacy boards and opinions," says Charles Dunham, an associate at healthcare law firm Epstein Becker Green's Houston and New York offices. "It's a new form of healthcare delivery and the government typically takes time to catch up and regulate."
Mr. Dunham's firm dove into the telehealth field years ago, initially representing physician practices utilizing telecommunication platforms to offer concierge medicine. He emphasizes that although telehealth and telemedicine are often terms used interchangeably, telehealth captures a larger umbrella of remote healthcare services. Telemedicine refers specifically to remote professional medical services.
Where telehealth is gaining steam
Telehealth found its roots in the direct-to-consumer. Patients sought 24/7 access to physicians via phone, text and email.
"That's where we saw it originally pop up. It has become more expansive with coverage from government and commercial payers," Mr. Dunham says. The use of telehealth services is expanding into other settings now, such as hospitals and skilled nursing facilities.
For example, some hospitals began creating virtual urgent care services. The service offers patients middle-of-the-night consults without a trip to the emergency room. Hospitals are also leveraging telemedicine for those patients who are already admitted in the ER, but aren't in critical condition. These patients can go into a private room and receive remote consults instead of waiting three hours in the ER.
Skilled nursing facilities are also using telemedicine services to their advantage, with the goal of reducing hospital admissions. Trained technicians at the patient site assist physicians in remote locations to assess and diagnose mild- to high-intensity disorders.
Employers with self-funded health plans are providing employees access to telemedicine consults, as well, with the intent of decreasing unnecessary urgent care visits to help control rising costs.
The regulatory & legal barriers of telehealth
Eventually, coverage and reimbursement will prove enticing reasons for providers to jump onboard with telehealth. Right now, however, payment for these services presents a barrier. Providers often have the following questions: "We want to roll out this model, but how do we get paid for it? And will we get paid the same way [we would] in person?"
Additionally, Mr. Dunham indicates the state-by-state licensure and regulatory framework is a major challenge at the moment; in particular, the ability to prescribe medications without an in-person consult. Many providers are also uncertain about the ins-and-outs of creating a physician-patient relationship via these services.
"By its nature, telemedicine services can be provided by a physician located anywhere. The fact is, that where the patient is located, you also need to comply with that state regulatory framework," Mr. Dunham explains.
He urges anyone interested in entering the telehealth field to become aware of the state regulations surrounding the practice.
Where telehealth is headed
Within the next one to two years, Mr. Dunham suspects telehealth utilization will grow as the industry becomes increasingly consumer-driven.
"The focus is to promote efficiency and make everyone's life easier, [telehealth] is one piece of the puzzle," Mr. Dunham says. "You're removing the brick and mortar."
Right now, more providers are adopting the technology than patients are choosing to use it. But once more individuals experience telehealth services, the industry will likely see the uptick of telehealth utilization.
"As the patient population changes, and those people who utilize those services increase, I believe you'll see exponential growth," Mr. Dunham concludes.