Telemedicine seemed promising in the beginning especially for patients in rural areas, but has slowed over the past decade. With any new innovation the rate adoption is always a factor of value to the user. In the case of telemedicine there are two users, patient and provider, however the rate of adoption seemed to be in the hands of the government and the technology providers. So who is really to blame?
Medical Billing and Reimbursements Problem
It should be of no surprise, but first let’s point out that US Government is heavily involved with regulating healthcare and even with the best of intentions, they create great disruption for some and opportunities for the opportunistic.
The claim, no pun intended, is that telemedicine adoption has suffered mainly because of reimbursements regulatory policies. As previously mentioned, medical billing and reimbursements are regulated by government and implemented by agencies. For example, agencies like the Centers for Medicare and Medicated Services (CMS). CMS has plans to implement systems and current procedural terminology (CPT) codes that would facilitate these reimbursement claims for remote-care, but they are slow coming. But the issues are more than just the missing codes that are needed for remote patient care and services to be reimbursed. The other issue is eligibility criteria for providers and who can participate as originating sites: Originating sites authorized by law are listed below.
The office of a physician or practitioner;
- A hospital;
- A critical access hospital (CAH);
- A rural health clinic (RHC);
- A federally qualified health center (FQHC);
- A hospital-based or critical access hospital-based renal dialysis center (including satellites) (Effective January 1, 2009.);
- A skilled nursing facility (SNF) (Effective January 1, 2009.);
- A community mental health center (CMHC) (Effective January 1, 2009.).
- NOTE: Independent renal dialysis facilities are not eligible originating sites.
[Source: CMS.gov]
I agree that regulatory policies and government is a major cause in the delay in adoption but it is not the only reason. Follow the money and you will see that the revenue produced by the healthcare industry is staggering compared to other highly regulated industries; financial and environmental.
Technology Adoption Problem
So is it the technology? There are two parts: Part 1: In my opinion, they have missed the opportunity to provide adequate value proposition supporting ease of use and seamless incorporation into our daily lives. Instead the majority of telemedicine vendor’s appliances is intrusive, clumsy and requires the assistance of a trained professional. The other major draw back is that telemedicine still requires on premise assistance. This is why I believe the technology has fallen short when it comes to delivering value to the customer, patient and provider.
Part 2: I will take a page from Crossing The Chasm, as I believe it explains the problem very plainly. In Crossing the Chasm, the author Geoffery Moore talks about Everett Rogers Diffusion of Innovation theory but explains that there is a chasm (a gap, a crater, or an abyss if you are not careful) between the early adopter’s of a new “tech” product and the early majority, the pragmatists (see the diagram below). He explains this phenomena by saying that early adaptors, and the enthusiasts are more in love with the technology or idea, but the majority of users, the pragmatists “cannot even figure out how to start using it.” I believe that this is where telemedicine is today; they are still trying to entice early-adopters with promos and hard selling programs.
Crossing the Chasm
What’s next, crossing the chasm? Having personally gone through a couple of medical interventions, as well as with family and friends, I would suggest that for Telemedicine to cross the chasm it needs to change the value chain. Let the “value to whom” target the family and loved ones, thus making the new value chain to be the patient + family + loved ones over the provider, payment and reimbursements. I think that families and loved ones will pay for these remote monitoring services because it will keep them informed as well as provide convenience and peace of mind. They will take action to include healthcare providers in the more traditional sense when needed. If successful, this will create the real evangelists for telemedicine. Next, problems should be easier to resolve with the new target customers. Address ease of use and integration, then market repositioning the products.
Telemedicine providers should also look to partner with the disruptive forces facing the industry. For example, wearable device companies can be adjacent possibilities. With the pervasiveness of wearable devices and wearable technologies making dramatic strides, it will continue to create opportunities for self-evaluation self-monitoring and self-diagnosis. And as the data becomes readily available for analysis, these health and fitness companies will synthesize the data to inform and help decision-making for the users. The disruption (or opportunity, depending on which side you are on), will be for healthcare providers, with the patient permission, to start integrating this information into their EHR systems to enhance their patient care services. Hopefully that too will not require CPT codes. <smile>