Community health centers (CHCs) should be able to take advantage of more flexible payment models to boost their usage of telehealth to provide their patients access to specialist care. But as a recently released report by the California-based Center for Connected Health Policy details, CHCs face a series of obstacles to making telehealth work for them financially, including the complexity of billing and reimbursement rules and the difficulty of tracking telehealth visits using their current data systems.
Introducing the report in a recent webinar, Mario Gutierrez, executive director of the nonprofit Center for Connected Health Policy, said CHCs face significant policy barriers to receiving reimbursement for telehealth, as well as operational issues. “They need to be able to make changes to improve care. To do that, new models of care need to be developed. They cannot sustain it as a separate, isolated cost center.” Telehealth visits must be seamless, he added, and CHCs should develop learning networks to identify and share knowledge and problems.
The Center contracted with consulting firm Milliman to study the financial workings of five California CHCs regarding telehealth. Susan Philip, a consultant with Milliman, who worked with those five CHCs, started her presentation by quoting one of the center’s leaders: ‘Telehealth is not a revenue generator and shouldn’t be seen as such. It is a modality. Looked at it on its own, it is a cost center. But there are strategies for improving revenue and enhancing adoption in the long term.”
The goal of the study was to better understand cost and reimbursement issues they face. Philip said the financial analysis revealed that the programs are not self-sustaining as currently operated. The telehealth programs all are being subsidized with grants or other health system resources.
Interesting for Healthcare Informatics’ audience was the finding that data systems are as much a part of the problem as the solution. “Tracking and data collection systems varied across the five CHCs studied for this project,” the report noted. “With other demands thrust upon the CHCs, tracking telehealth encounters proved to be difficult and cumbersome. For example, one CHC is currently working with two different electronic health records systems: one for mental health providers and one for medical providers. Certain contracted distant providers do not use either system. Therefore, to develop a complete picture of the telehealth program, the telehealth coordinator must manually track every encounter on a telehealth log. Another common issue is that typically a CHC’s billing system and EHR system are separate, with different user access points. This lack of interoperability between systems and user access points creates administrative burdens for billing staff and telehealth staff interested in tracking the total charges, revenue, and payments to the distant provider associated with the same telehealth encounter.”
Ann Truscott, telemedicine coordinator at South Lake Tahoe-based Barton Health, said aligning the telehealth program with the organization’s overall strategic goal is very important. She said Barton, which has a hospital and nine total sites serving 152,000 patients, has faced challenges from structural and personnel changes. Barton hosts between 150 and 200 telehealth visits each month. The health system moved from multiple charting systems to one EHR, and has gone through three IT directors and several medical directors. “Based on the information in the report, I think we need to have a strong billing representative on the telehealth team,” Truscott noted, because she is a nurse, not a billing expert. She said pulling data about telehealth usage for analytics purposes is a challenge.
The report encourages provider organizations to produce routine, standardized reports that track telehealth encounters through the EHR and billing systems to get a clearer picture of telehealth encounter volume. “Those reports can be used to reconcile patient demographics, clinical information, and financial information while interoperable systems are developed and implemented,” the report said. In an effort to accurately track telehealth encounters, CHCs should consider creating an identifier in the EHR and billing systems so telehealth-related encounters are easily tracked and identified.
Among the report’s recommendations for policymakers:
• Change current federal laws regarding the reimbursement of telehealth delivered services under the Medicare program including geographic, facility, services and provider restrictions.
• Eliminate the current requirement of “face-to-face” in the definition of a “visit” for a CHC on both the federal and state level.
• Change both Medicare and Medi-Cal policy of multiple visits in one day.
In summary, the report found that despite the value they provide to patients, telehealth programs, especially those with low volume, cannot be sustained by traditional reimbursement models. Several of the CHCs in this study are using grants to pay for parts of their telehealth program. Continuing to seek grants from both public and private sources is a useful short-term strategy but does not lead to a self-sustaining program at scale. Better-coordinated data systems can help them get there. (The next issue of Healthcare Informatics will include a feature story on telehealth policy changes taking place across the country.)
