Show payers the value of telemedicine services

Offer free 'trials' to establish credibility

Three years ago, Visiting Nurse Services of the Northwest in Mountlake Terrace, WA, began offering telemedicine services to a wide range of patients. The new technology not only improved patient care but also allowed staff members to efficiently manage visits while still offering continuous monitoring of vital signs for patients with ongoing cardiac, respiratory, or diabetic conditions.

The benefit of using telemedicine for Medicare patients is that you can better manage the number of visits needed to ensure good outcomes; therefore you can control costs, points out Patricia Mulhern, RN, MN, vice president of patient services for the agency. The agency didn't limit the use of telemedicine to Medicare patients, however. "We saw an opportunity to use telemedicine as a marketing tool to attract new referral sources," she says.

"Our No. 1 market is our referral sources, which are physicians and payers," explains Mulhern. "We must have physician orders for telemedicine; so we do spend time explaining telemedicine to physicians and their staff," she says. Because a physician's support of the technology is important not only to getting the referral but also to the patient being receptive, Mulhern's staff carry a telemonitor to the physician's office so that the physician and staff members can see how easy it is for the patient to operate. "The hands-on demonstrations are very important," she adds.

At Presbyterian Healthcare Services in Albuquerque, NM, staff members' constant communications with physicians and written reports of the results of the patient's monitoring increase physician support of the program. "We are part of an integrated health system; so we don't have to do a lot of marketing to physicians but it is important that they are supportive of their patients who are on telemedicine," explains Cheryl Reese, BSN, MBA, clinical education specialist at the agency.

"We have also found that the most important part of marketing a telemedicine program is to make sure your staff members understand the program so that they can speak positively about it when asked," says Reese. Telemedicine is discussed at staff meetings and reports about positive outcomes for telemedicine patients are shared.

"We do market telemedicine to the community, at all of our events for the senior members of our health plan," she says. Flyers, educational displays, and demonstrations explain the program and how it works, Reese says.

Another market that Mulhern's agency is pursuing is managed care and private insurance. "It is easy to gather data on Medicare patients who are on telemedicine, but the data doesn't always apply to patients of other payers," says Mulhern. "We did not want to wait until we had enough data on non-Medicare patients to approach payers about reimbursement for telemedicine; so we go to a payer and offer to add telemedicine to the care of one patient for no charge," she says.

Once the patient is discharged from care, the agency and payer look at the savings and improved outcome for the patient. "We point out the savings and suggest that they share the savings with us by reimbursing us for the telemedicine portion of the care," Mulhern says. Medicare does not reimburse for telemedicine but because agencies can reduce costs with reduced visits for the same outcome, the agency does see a savings, she points out. "Because private payers tend to pay per visit, they are not set up to reimburse telemedicine as a separate service," she says.

Telemedicine reimbursement is not part of any payer's standard contract so it does take time to work out details, says Mulhern. To avoid giving away telemedicine for a long period of time, be sure to set the parameters of the test case at the beginning, she suggests. "We usually say the test will run for one episode of care, or 60 days," Mullhern explains. "If you let it run indefinitely, there is no reason for the payer to make a decision, and when you do finally stop the service, your staff may feel as if they are abandoning the patient." She adds, "By defining the length of time for the test case, all parties involved understand when it will end."