By Stewart Levy, R.Ph., MBA
We are at a tipping point where our healthcare system is demanding improved efficiency in care delivery including improved access and less cost. Technology is clearly ahead of adoption. A recent Deloitte survey in 2018 found 57% of consumers would be willing to try a virtual visit and 18% of physicians are planning on implementing telemedicine in the next two years. From a hospital or clinic perspective, there are a number of proven benefits including:
- Extend care services to patients who live in rural or remote areas including occupational health
- Minimize hospital admissions and readmissions by triage and addressing non-emergency concerns
- Monitor and manage long-term and post-hospital patient care at home
- Increase the number of patients who can be seen and treated by staff
- Coordinate care delivery with multiple specialties, primary care, and trans-disciplinary care
- Provide new streams of revenue in the form of virtual consultations and assessments
There are various types of telemedicine and connect care digital health including:
1. Live Video (Synchronous)
2. Store and Forward (Asynchronous)
3. Remote Patient Monitoring (RPM)
4. Mobile Health (mHealth)
5. Electronic Consultants – (Provider to provider)
Comprehensive telemedicine solutions usually require the development of a telemedicine clinic, kiosk, or mobile cart. These telemedicine platforms include technology that gives providers a mobile frame and storage system to carry cameras, computer monitors, keyboards, computers, and mobile medical devices. Carts look similar to standing work desks with computer monitors instruments and wheels at the bottom for easy moving.
Digital Cameras
In order to do video conferencing, you will need a webcam. Some telemedicine providers offer high-end, high-resolution digital cameras for crystal-clear video capture. Others offer specialized medical examination tools with integrated cameras that allow healthcare professionals to take detailed medical images (e.g. the inside of a patient’s ear) and then share them with a specialist at another location.
Telemedicine Kit
Healthcare providers who are routinely providing frontline care in remote areas need portable, durable telemedicine kits. Telemedicine equipment kits often look like sturdy briefcases or large medical kits. Inside, these kits may include a small computer with an integrated screen, camera, and simple mobile medical devices.
Mobile Medical Devices and Remote Patient Monitoring
Mobile medical devices are often used by either healthcare professionals or patients to capture medical data and send it to a medical professional at another location. Some telemedicine providers offer packages with basic instruments or even require the purchase of a patient monitoring system. Devices include instruments that can track patient’s responses to questions and then sends the data to a physician. Other digital mobile medical devices might include glucose monitors or an ECG device.
In the case of store-and-forward telemedicine solutions where a healthcare provider is examining a patient at one location and needs to share visual medical information with a doctor at another location, the equipment is more sophisticated. Telemedicine device companies offer a range of medical scopes that have integrated visual and audio recording devices. Some scopes allow the provider to capture images of the exam and then share them with other devices via a USB port. Digital stethoscopes let physicians record and share a patient’s heart and lung sounds.
Software
Telemedicine solutions are moving to the cloud. However, some telemedicine providers still require the purchase of a software system that needs to be installed on a medical practice’s computers. These software solutions may require data storage hardware or servers. All software should be checked for compatibility with a healthcare provider’s computer operating systems. It’s best to look for an integrated solution to implement one software program for live video conferencing, another for store-and-forward telemedicine, and another for collecting and monitoring patient medical data remotely.

Solutions and HealthWell Advisors
Fail to Plan – Plan to Fail
There’s a lot of innovative, sophisticated digital health equipment out there. However, it’s most important to start by developing a population health plan including financials for your patients first. There are new reimbursement models in place with Medicare, carriers, and employers that encourage the use of telemedicine. Also, states regulate telemedicine and approve types of providers and reimbursement, so get all of your “ducks in a row” first before you purchase the first piece of equipment.
Fees and Reimbursement
Here are a few questions to ask when determining how to charge for this service:
- Which CPT and HCPCS codes can be completed via telemedicine?
- Are there any restrictions on the location of the patient or provider?
- Do I need to use a modifier (GT)?
- Does the reimbursement rate match the in-person rate? • Which providers are eligible (physician, NP, PA, etc.)?
- Are there any specific notes that need to be included in the visit documentation? ←
