An Open Letter and Call To Action to the Telemedicine Industry

“Is your cucumber bitter? Throw it away. Are there briars in your path? Turn aside. That is enough.”
Marcus Aurelius, Meditations.

For an industry full of innovators, there’s a distinct lack of innovation in overcoming the reimbursement issue. I believe this is largely because we’ve trained ourselves to continue focusing on reimbursement, rather than discovering how to make the lack of reimbursement work for us or on creating a new model of telemedicine that makes reimbursement an afterthought.

If you believe telemedicine won’t expand until reimbursement is solved, why are any of us involved in Telemedicine? (I assume it’s to improve healthcare, which means we shouldn’t let reimbursement stop us.)

This is not to say that reimbursement is not important and that this issue shouldn’t be worked on. We wholeheartedly agree that it is of great importance and needs to be worked on. We just don’t believe it should, by any stretch, be a showstopper. There have already been plenty of indicators that, as a bottom line issue, cost savings from proper implementation of telemedicine negates the revenue loss of

reimbursement and, often, creates a net positive without it. (We discuss some of those findings here.) Additionally, there are organizations–wonderful ones, like the American Telemedicine Association (ATA)–already working on and making progress in payment reform (among other subjects), so that we can focus on the technology that can change healthcare around the world.

Many of the articles I see in the various industry groups on LinkedIn focus on “barriers to adoption” and “hurdles” and such. These often, if not always, refer to reimbursement. They ask,” Why hasn’t telemedicine taken off?” Within the first few comments will be something about reimbursement.

Unless you quit your day job and become a politician, you likely won’t sway legislation. Given today’s partisan politics at both the state and federal levels, it’s pretty likely you wouldn’t sway it even then. And, as mentioned above, we do have groups and organizations already working to push telemedicine legislation. States ARE coming around, slowly but surely. All indicators point to reimbursement for the full range of telemedicine use happening at some point. But we have technology NOW that can save lives NOW, and I don’t believe we should wait.

As for insurance companies: They are coming around as well; so are large employers. These organizations have great incentives to bring costs down, and are pushing telemedicine and telehealth in general in a great many ways. But this is still a slow process, and many reimbursement questions won’t be sorted out until insurers can catch up with all the possible ways they can take advantage of telemedicine when not forced into it by legislation.

So what choice does that leave us? We must become champions of our own industry. We must be creative. Reimbursement is the briar (or boulder) in the path for others (ATA, state legislatures, insurers) to cut down. We, of course, support and belong to organizations/movements such as ATA. Join. Participate. But as individual companies, our job at the moment is TO GO AROUND.

“Obstacles don’t have to stop you. If you run into a wall, don’t turn around and give up. Figure out how to climb it, go through it, or work around it.”
Michael Jordan

The industry is focused on a problem it doesn’t have the power to directly change through product innovation…and it is causing the kind of stress the Serenity Prayer was meant to counter. Remember, the first line asks, “…grant me the serenity to accept the things I cannot change.”

Since we cannot immediately change reimbursement but are planning to push forward with telemedicine anyway, we must now look to the second line of the prayer, “…grant me the strength to change the things I can.”

What can we change? Spending and budget models for clinics? Possibly. New non-insurance billing models for services? I don’t know. As Edison said:

“Hell, there are no rules here – we’re trying to accomplish something.”
Thomas A. Edison

We have to chuck the rule book. We may have to create a new way of presenting healthcare that is currently not used. I couldn’t begin to guess what that will look like…we haven’t done it yet! (Although we’ve had some success seeing companies recouping costs and increasing operating revenues via cost avoidance. I have no doubt that will be part of the new rule book.)

What I do know, is that we have to believe that we can create this new model. We are driven, hopefully, because we believe our technology will make a positive difference in many, many lives…and that we’ll be successful as a result. To do that, we need to be just as innovative with the business model for telemedicine as a whole…especially for the smaller practices and clinics for whom reimbursement is a tremendous top line pressure…as we are with the technology itself.

As the saying goes, “Technology is nothing without meaningful use.” Is reimbursement really what’s preventing that meaningful use? Or is it our obsession with reimbursement? How can we ensure our technology gets used in a meaningful way while sidestepping reimbursement?