Photo courtesy of MedSign
One of the latest innovations in telehealth uses old technology, the television set.
MedSign CEO and cofounder Tom Conroy came up with television technology called Qortex so that his father, a World War II veteran who didn't use a computer or own a smartphone, and others like him could access both the video and audio component of telehealth.
Qortex provides real-time visual, voice and vital-sign data access.
"This is a new paradigm, as opposed to a new norm," Conroy said. "You have to create a system that's simple to use."
The cost to providers for the Qortex system is about $99 a month. Physicians log in and click on the patient's name for the scheduled call. A message comes up on the TV that there is a call coming in, with instructions to press OK on a remote to begin the two-way virtual communication.
Internet access is needed for Qortex to work. Many televisions today are smart TVs, which creates a ready-to-use system. However, a smart TV is not required, Conroy said. Rather, Qortex makes TV an intelligent platform through the use of a cable system that connects to the Qortex box, allowing for the pass-through technology.
While some experts have touted that senior citizens are using computers and smartphones to access their physicians for telehealth visits, they're usually referring to the younger demographic of seniors in their mid-60s and 70s, not adults in their 90s like his father, Conroy said.
Medicare and Medicare Advantage plans have been covering telehealth visits, but they are not reaching the populations that are often most in need of virtual care. These include not only the elderly, but the poor and disadvantaged, he said.
WHY THIS MATTERS
MedSign released Qortex in March, just as the World Health Organization declared COVID-19 a pandemic and a Public Health Emergency of International Concern, and as the United States declared a public health emergency.
During the pandemic, the use of telehealth has skyrocketed.
The Centers for Medicare and Medicaid Services issued new flexibilities on the use and reimbursement of telehealth visits during the public health emergency. CMS recently began proposing to make some of these flexibilities permanent following President Trump's executive order on Improving Rural Health and Telehealth Access.
But providers and private insurers are still weighing telehealth's future based on where CMS and Congress land on policy, particularly regarding payment.
From the provider side comes the concern over whether the payment parity between an in-person or virtual visit will remain when the pandemic ends. Telehealth takes an upfront investment that some hospitals and physician practices may be reluctant to make if the reimbursement is not there. So far, CMS has yet to weigh in.
Private insurers are still working out telehealth reimbursement policies going into 2021 and beyond.
"Commercial carriers are reimbursing at the same level as in-person visits, we know that's going to change," said Daniel Marino, managing partner of Lumina Health Partners, during the HFMA Digital Annual Conference yesterday.
Reimbursement for telehealth visits from the home is still in question.
Under waivers issued during the pandemic, Medicare can pay for an office, hospital and other visits furnished via telehealth, including in a patient's residence. Prior to this waiver, Medicare could only pay for telehealth when the patient receiving the service was in a designated rural area.
Providers need to know they can get reimbursed for a telehealth visit provided in the home, Conroy said. Insurers need to get caught up to the technology, and the technology is not keeping pace with Trump's executive order, he said. But he believes that by next year all of this will change in telehealth's favor.
THE LARGER TREND
The Qortex system is currently used by home-care agencies in Florida and Southern California.
The Department of Veterans Affairs has also taken an interest, Conroy said. A team from the VA visited MedSign. "They directed us how to be a vendor of the U.S. government," he said, but an announcement on a deal is still pending.
Telehealth is able to help prevent hospital readmissions, which cost hospitals fines of $800 million in 2019, according to Conroy. Eighteen percent of all discharged patients end up back in the hospital.
Instead of sending nurses in person who can see maybe six post-acute patients a day, virtual visits can more than triple that number. Chronic care management can also be performed through telehealth, he said.
There are challenges ahead for all stakeholders: Providers need a fully integrated system; payers, including CMS, need to know that services won't be over-utilized through both virtual and in-person care; and all need fraud-prevention practices in place.
Conroy is amazed, he said, that "in the year 2020, we don't have the capability to provide quality care in the comfort of our home."
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