A study by McKinsey & Co highlighted that in 2019, only 11 per cent of U.S. consumers accessed telehealth services, while in 2020 it was up by 46 per cent. These statistics were shared by Peter Nardi, Network Manager, North America, GMMI Inc., who was speaking at the 'What’s on the Tele? International private medical insurance, telemedicine and remote second opinions', a session at the 2020 USCIPP annual meeting.
According to Nardi, telemedicine showed us how necessity breeds invention. He highlighted that one of the areas where telemedicine would be beneficial is bariatric surgery. This is the type of care that requires patients to have a strict adherence to protocols even before the surgery, which requires a lot of pre-care and post-care. “I think a lot of that can be done virtually. If hospitals can work on certain pricing that they can offer for these programmes that would be attractive for insurance companies. If that is done correctly, there might be a way to work with nutritionists, dieticians, and other doctors from a virtual perspective, to have these patients not travel,” he explained.
If telemedicine is here to stay, stressed Nardi, then are certain issues that need to be addressed. These include factors such as if the provider has necessary certifications to do e-prescriptions. “There are platforms and companies that provide these certifications but are all providers aware of that? Are doctors aware of that?” he said.
Other challenges include coding, pricing and reimbursement. Providers must ensure to properly code claims to reflect virtual visits as opposed to hospital visits. “There is going to be an expectation of having visibility of the fee schedules,” he added. “There should also be a look at if reimbursements should be lower. We look at it from the vantage point of if doctors are treating more patients virtually, they should be able to treat more patients overall, as time spent with those patients is less. Due to the pandemic, a lot of insurance companies also made the right decision of waiving co-pays and deductibles, so that the cost is lower.”
Regulatory challenges
The interest in cross border telemedicine has evolved from something of a novelty and a luxury to a real service line with growing revenue, highlighted William Ferreira, Partner, Hogan Lovells, at the ‘Regulatory trends in the delivery of international telemedicine and remote second opinions’ session.
He said: “Telemedicine is not just for patient care now, it’s for scientific research, remote data collection and more. What we are finding is that foreign regulation in this area is straining to keep pace with modern technology. Nobody doubts how important it is to leverage telemedicine especially during this pandemic period and beyond. But there is some doubt in many countries on how to regulate telemedicine and how to regulate it especially when the physician and the patient are in different countries.”
Compared to just a few years ago, U.S. hospitals are bringing a systematic approach to the business strategy in telemedicine. Furthermore, the amount of market research and competitive intelligence that’s being developed in this area is also substantial and growing.
However, the location of the patient is critical because it drives the law applicable to the hospital, physician and patient, whether it is a remote second opinion business or relationship with a managed care plan or an insurer, explained Ferreira.
“That’s why so many institutions have spent time exploring country-by-country regulatory parameters that apply to these programmes. It affects the viability of these virtual service lines in a very real way,” he shared. “While the practice of medicine is regulated around the globe, the practice of telemedicine can be referred to as a blurry patchwork. Where countries do regulate telemedicine, those laws do not necessarily address the circumstances where the physician and the patient are situated in different countries.”
Moreover, Adilene Rosales, Associate, Hogan Lovells, gave the example of Saudi Arabia, where they have issued telemedicine regulations that define it broadly but define teleconsultation in such a way that it can only be delivered through certain mediums. Interestingly enough, it can’t be audio-only. While in the UAE, especially Abu Dhabi, the physicians who will be consulting with each other must have an established collaborative partnership, which is evidenced by a written agreement that divides up the responsibilities and liabilities of both the parties.
Rosales added that if a country’s telemedicine framework is underdeveloped or non-existent then the regulations that govern the traditional practice of medicine could be referred to.
Nardi concluded: “Even if a vaccine does come out, I think we are going to be more creative and collaborative on figuring out ways from the international perspective of how we can keep patients in their home countries.”
What is the difference between telemedicine and second medical opinion (SMO)?
Telemedicine is using technology to treat someone at a distance. On the other hand, SMO is a service that will verify a diagnosis to the recommended treatment plan.
