Robert Graham Center Research

Low Use of Telehealth Tied to Flawed Payment Models

August 31, 2016 01:39 pm Michael Laff

A lot of physicians and insurers might recognize the potential benefits of telehealth, but one author of a recent study said inadequate support from payers keeps more family physicians from using the technology.

[Male physician working on electronic tablet]

A study conducted by the Robert Graham Center for Policy Studies in Family Medicine and Primary Care found that family physicians who used telehealth were much more likely than nonusers to work in federally designated safety net clinics (28 percent versus 15 percent) or HMOs (19 percent versus 11 percent). Academic health centers reported the lowest use of telehealth.

Titled "Who is Using Telehealth in Primary Care? Safety Net Clinics and Health Maintenance Organizations,"( the study was published in the July-August issue of the Journal of the American Board of Family Medicine.

The research was based on a survey conducted by the AAFP in 2014 in which 15 percent of the 557 family physicians who responded said they had used telehealth technology in the previous year.

One study author told AAFP News that a key hindrance to family physicians adopting telehealth technology is that Medicare and many commercial insurers do not pay for telehealth services. Physicians do not see a difference in quality whether care is delivered by telehealth or in person, said Graham Center researcher Megan Coffman, M.S., but the incentive to use the technology is low if they are not reimbursed.

"Payment is not aligned with services yet," she explained. "We have to find different ways to incentivize rural providers to use it, and not just through fee-for-service."

Coffman suggested that if Medicare began paying for more telehealth services -- a change that the AAFP is pressing CMS to make -- the move could have a cascading effect on other insurers. Payment could come in the form of bonus payments in the same way practices are encouraged to use electronic health records.

HMOs have a greater incentive to use telehealth because some insurers are paying them on a capitation basis, which encourages them to keep patients out of the hospital.

"If you have a telehealth visit at 9 p.m. on a Friday instead of sending the patient to the emergency room, that will reduce overall costs," Coffman said.

The survey did not ask physicians if they were the originating site for telehealth consults. Some telehealth visits occur when a primary care physician consults with a patient in the same room while contacting a specialist via digital connection.

Despite its promise, little is known about how the technology is used across different practices.

"More research is needed to find out why certain practices are using telehealth and what incentives are necessary to expand its adoption more widely," Coffman said.

Related AAFP News Coverage
MedPAC Explores Expansion of Payment for Telemedicine

2015 State Legislative Conference
Survey: Telehealth Increases Access to Care, Continuity


Gauging the Promise and Perils of Telemedicine
AAFP Calls for Adequate Payment, Fewer Restrictions


More From AAFP
Member Interest Group: Telehealth

Family Practice Management: Should You Treat Your Patients Virtually?
(July-August 2015)