Doctors limit US expansion of telehealth -- but the VA knows the value

The VA continues to "set the telehealth table." That line is from 2010 when the VHA's telehealth pioneer Adam Darkins observed: "“The patients have to do less travel, and they can get problems resolved quickly.… They feel the care coordination system is their lifeline." The program was cited as having 43,000 Veterans enrolled with a long road ahead. Fast forward to 2014 -- the VA's Telehealth program served 690,000 veterans in its most recent fiscal year, or 12% of all veterans. And the long-term study of members of the Geisinger Health Plan showed a 44% reduction in readmission rates of those monitored in a 4-year telehealth study.

Telehealth definitions are confusing. So let's assume for the moment that telehealth is the technology market of providing remote care and/or monitoring of a patient's status or condition. I made that up. Here is the real definition from the US Government (broader than telemedicine and referencing 7 other definitions). And here's another policy site that links to the policies in all 50 states and another linking to the Institute of Medicine that limits the concept to serving those that are 'underserved.' Call me crazy, but that waffling sounds like doctors weren't fully on board with the idea of non-rural and well-served patients avoiding a trip to the office.

How big is the telehealth market as viewed then -- now and in the US? Slipping back to 2010, a mere four years ago, the global 'telehome' (telehome? seriously?) market was valued at $2.9 billion. Oh maybe not, a Forbes article cited another analyst firm which sized the US portion at $240 million today growing to $1.9 billion in 2018.   And the global telehealth market?  Oh my! From just $6.5 billion in 2013 to nearly $24 billion in 2019.  Not in the United States, though. Medicare restricts the growth of telehealth in non-rural areas by only reimbursing providers for telehealth visits that are "in a professional shortage area or outside of a metropolitan statistical area."  

Lift the restrictions and watch the explosive growth to the benefit of seniors. One can theorize that this restriction can only have been designed by and for the benefit of those very professionals who have fixed infrastructure costs in urban locations. Of course they have reimbursement rates that are tied to in-person -- if very brief -- face-to-face contact. Note the new Medicare Parity bill and its supporters -- of course the American Telemedicine Association was noted. Absent but predictably accounted for, was the American Medical Association. The AMA has spent anywhere from $15 million to more than $22 million annually between 2010 and 2014 lobbying issues that its members care about.  Does the AMA want telehealth to be a broad-based reality?  Uh, not exactly. It appears that doctors don't really want the patient to 'do less travel and get problems resolved quickly.' How sad for American seniors.