A New Year for Telehealth

As we embark on a new year, we at SimpleVisit thought it would be good to look back at what has happened in the telehealth industry throughout 2018 and what is on the horizon for 2019.

State Legislation

In 2018, 65 legislative bills and 49 regulations were passed that involved telehealth in some way. According to CCHP’s Legislative Roundup, Illinois saw the most passed legislation, with CA and UT following closely behind. The bills covered a wide span of topics – their breakdown looked like this:

• Substance use disorder: 4
• Regulatory, Licensing & Advisory Boards: 14
• Provider-Patient Relationship: 3
• Private Payer Reimbursement: 8
• Online Prescribing: 2
• Network Adequacy: 2
• Medicaid Reimbursement:12
• Demonstrations, Grants & Pilot Projects: 6
• Cross-State Licensing: 8
• Broadband: 5
• Other: 4 (including school-based telehealth, provider use disclosures, extensions/changes to previously-established collaborations/commissions)

Federal Legislation

In the federal arena, there were two major bills passed in 2018 that saw considerable advancements for policy surrounding telehealth: the Bipartisan Budget Act, which made changes to Medicare covered services and requirements for telehealth reimbursement, and the SUPPORT for Patient Act, which attempted to relax regulations on and expand services through telehealth for the purpose of addressing the national opioid crisis.

Trends & Movement

Throughout 2018, there were certain trends in terms of what saw forward movement, how it was being used, and what innovations were being developed. Here are the five trends that were most significant that are most likely to continue and have major impact in 2019:

1. BARRIER REDUCTION: There was significant progress made in reducing barriers to telehealth utilization and reimbursement, specifically in cross-state licensing and Medicare reimbursement. The Interstate Medical Licensing Compact went from 18 participating states to 24 states, Washington DC, and the territory of Guam. Other interstate compacts saw forward movement as well. The Nursing Licensure Compact transferred to the Enhanced Nursing Licensure Compact with updated requirements and ended the year with 31 states. The physical therapy and psychiatry compacts both gained enough states to go live in 2018, with 21 and 7 states respectively. REPLICA, the compact for EMS licensing, now has 16 states and has officially moved into the next stage of enactment, with the commission currently finalizing regulations and requirements. Perhaps the most significant advancement in overcoming this barrier, the Veterans Administration (VA) enacted a new policy, dubbed the Anywhere-to-Anywhere legislation, that exempts VA providers from cross-state licensing requirements when providing medically appropriate services via telehealth. (For information on these compacts, policies and more, please visit our Resource Library.)

CMS, traditionally stagnant and resistant to advancement and change, finally saw forward movement in regulations on and reimbursement for telehealth. The Bipartisan Budget Act removed originating site geographic and facility type requirements for virtual diagnosis, treatment and management of acute stroke and telemedicine follow-up and management of End Stage Renal Disease with some in-person visit requirements. In the newly published Physician Fee Schedule for 2019 they offered expanded virtual services that will be covered through Medicare:

• Virtual check-ins
• Remote Patient Monitoring (instituted a policy change where it is no longer defined as “telehealth” by CMS, and added new codes)
• Intraprofessional eConsults
• Added telehealth codes for Prolonged Preventative Services

Also this year saw every state’s Medicaid program cover some type of telehealth application and 39 states have active parity laws for telemedicine.

2. USE-CASE EXPANSION: 2018 also saw expansion in the use-cases for telemedicine in the public health sector. School-based telehealth saw a drastic increase in adoption and utilization in 2018. Even more importantly, telemedicine is now routinely being offered directly from providers, instead of through insurance companies as separate services, and is being increasingly integrated with all other services a medical office provides as a useful, included tool rather than an add-on, optional accessory to traditional care.

3. UTILIZATION INCREASE: The overall utilization of telehealth increased, with some states seeing massive growth in virtual visits after parity law enactment or improvement, like the 77.5% increase in MI. More and more practices were implementing telehealth programs, with 40% stating that they were implementing telehealth or planning on doing so for their practice in 2018.

4. TECHNOLOGY & MARKET INNOVATIONS: The technology market for virtual care devices saw substantial growth and innovation as well, with two to three new devices being developed or approved every month in 2018. These included ingestible data collection tablets, beds that deliver up-to-the-minute medical data remotely, and devices for remote observation and evaluation, particularly for specialties like opthomology and dermatology.

There were also a number of important corporate market changes in 2018, with acquisitions and mergers of telehealth companies seeing major impact. Among those were InTouch Health’s recent acquisition of Reach Health, AmericanWell’s merger with Avizia, Teladoc absorbing Advance Medical and Amazon’s purchase of PillPack. Also notable was CVS’s MinuteClinic beginning to offer telemedicine services.

5. BEST PRACTICES: As telehealth adoption, technology and reimbursement charged full-steam ahead, 2018 saw also a strong push for guidelines & how-to’s from experts in the field – physicians, payers, and lawmakers alike wanted to know how to do it right. The Medical Group Management Association, Federation of State Medical Boards, American Telemedicine Association, and American Psychiatric Association all put out Best Practices and Guidelines this year. Also, the Clear Health Quality Institute had its first graduating class of accredited telehealth providers, and rolled out new accreditation program offerings by the end of 2018. The National Telehealth Technology Assessment Resource Center announced that they are currently in the process of updating their technology toolkits, and the National Policy Resource Center, the Center for Connected Health Policy, released an updated website and resource line.

All considered, 2018 was an incredible year for telemedicine. As we start this new year, it is clear we have reached a turning point in the world of virtual care. We are more excited than ever to see what 2019 has in store for vendors, providers, and patients.

About Simple Visit

SimpleVisit is a video service which allows patients and providers to connect over the video platform of their choice. With SimpleVisit providers are able to deliver on-demand visits to patients over any device or platform they have available to them. For more information on SimpleVisit and on how we are enabling providers to host virtual visits check out www.SimpleVisit.com