Making the Business Case for Telehealth in the Ortho Practice

Is the American public finally catching up to telehealth? All the latest signs point to a patient population that is eager to try remote care visits. But are clinicians equally as interested in software that allows doctors to make a digital house call by using the Internet? What about payers? Are they embracing treatment modalities that include telemedicine visits? How do telehealth applications tie into the new shift from fee-for-service to value-based care?

This article will look at the state of telehealth and the business case for using it in the orthopedic practice.

The concept of “value-based care” is strongly tied to the reduction of costs in healthcare. With healthcare costs expected to skyrocket by 2025, tying reimbursement to streamlined efficiencies in hospitals and medical practices makes good business sense.

This imperative means that all practices, including orthopedic specialties, should continue to seek ways to alleviate costs while improving patient outcomes. This is particularly important because orthopedic practices are experiencing reimbursement reductions tied to the large (and growing) Medicare population and their utilization of ortho services.

It might be controversial to suggest this, but — Is there still “value” for the doctor in a very routine 15-minute on-site recheck after a surgical procedure – especially when there is ample evidence that a telehealth visit could be more efficient?

One example of how telehealth can be used to streamline patient workflows comes from Dr. Alfred Atanda, who wrote an article recently in AAOS Now. He’s found value in telehealth applications for established patients with simple follow-up discussions and re-checks. He stated, “In our department, an in-person visit takes an average of 68 minutes per patient, from check-in to check-out. The patient spends almost half of that time waiting.”

Dr. Atanda says telehealth visits run, on average, 17-minutes. So, the lower overhead associated with these visits is a key factor that holds the potential to reduce costs in any clinical setting – including the orthopedic practice.

But does telehealth pay?

Value-based care is coming to a practice near you. But so is reimbursement for telehealth. CMS reimburses for telehealth applications, and the majority of states have passed parity laws requiring private insurers to reimburse at the same rate as for in-person visits. According to Sage Growth Partners, 150 pieces of legislation have been recently introduced in 44 states to help lift restrictions on telehealth and improve access to technology. Currently, five of the largest commercial payers have telehealth reimbursement in place:

• Aetna
• Blue Cross Blue Shield
• Cigna
• Humana
• United Healthcare

While the majority of these payers only reimburse for live video visits currently, there is strong evidence that the payer community is embracing telehealth applications. A recent Healthcare Law Today article stated, “Payers are finally beginning to realize what many providers have known for some time – telemedicine brings cost savings and improved patient-member satisfaction.”

The Center for Connected Health Policy has an excellent state-by-state reimbursement guide. Click here to see it.

With 97% of patients expressing frustration with the amount of time it takes to see a clinician, telehealth holds real promise for improving patient satisfaction scores. But working telehealth applications into the established orthopedic patient workflow may prove challenging to physicians that are unwilling to embrace this kind of change.

Some practices may prefer offering these services as an alternative to traditional in-house visits – at least at first. Others may prefer to offer this option only to established patients. No matter how telehealth applications are employed, there are several clinical situations that may justify the use of the technology.

For example, telehealth can be used:

• For post-op surgical patients and routine follow-ups. While the majority of these visits are fairly routine, there is always the potential for the post-op patient to skip this visit due to the hassle of traveling to the office with a new knee, hip, or another orthopedic issue.
• Workers’ Compensation patients can be difficult to treat. Non-compliance with exercise regimens at home can cause the injured patient delays in returning to work. Telehealth applications can be used to engage the patient and hold them accountable to complete their treatment plan.
• Wound assessment requires a quick look to determine that the injury is healing properly. While the patient may have questions the outcomes are typically, “Looks like it’s healing well,” or, “Let’s prescribe an antibiotic.” Transitioning to a telehealth visit for these types of visits saves patients from the travel time it takes to visit the doctor’s office. For the physician, a 15-minute visit could turn into a 3-minute visit with telehealth.

“While telehealth can ward off some significant length-of-stay (LOS) and return-to-hospital penalties, a larger risk is the loss of patients in a highly competitive market where providers are viewed as interchangeable and the level of service is a clear differentiator.”
Making the Connection: Is the Telehealth Market Ripe for a Boom?
Sage Growth Partners

Sage Growth Partners recently released a report detailing the business case for telehealth. In it, they identified four-key benefits of this technology:

1. Increased access to care, which is particularly important in rural areas. With estimated provider shortages looming, and more than 50 million people living in rural areas, telehealth stretches our resources and provides much-needed care.
2. Reduced costs, particularly in the medical practice. One study showed primary care providers using telehealth applications saving $126 per visit over an in-patient exam. Another study stated that if all U.S. emergency departments were equipped with telehealth, 850,000 trips could be avoided with a cost savings of $537 million annually.
3. Patient satisfaction scores are particularly important in a value-based care model. In traditional visits, the average time needed for a 20-minute appointment is about two-hours, when you factor in travel and wait time. Clinical studies show very high patient satisfaction scores for telehealth. A study of a CVS telehealth application showed a 94 to 99% satisfaction rating. These results are typical.
4. Quality of Care improves with telehealth. It should be noted that these visits are not meant to replace all in-person visits. But telehealth-enabled ICUs are showing improved clinical performance including reduced mortality rates, according to one study.

OrthoLive would like to speak with your team about the business case for telehealth in your practice. The time is right for our application to improve patient outcomes and your bottom line. Contact us today.