As the United States struggles with healthcare reform, including trying to figure out how to provide healthcare coverage to all Americans without having an ample supply of providers, one possible remedy looms on the horizon. Telemedicine has proven to increase access to care and reduce costs via teleconsultations and remote patient monitoring. Unfortunately, the adoption rate in the U.S. has been rather slow. We have all seen the reports about how technology savvy millennials are and how they crave easy access to everything, including now their access to healthcare. Combine this with the benefits of telemedicine and we see the reasoning behind the shift toward telemedicine acceptance.

Many practices are hearing about telemedicine and becoming increasingly interested in how such a program could be implemented in their operations. Physicians want to start a telemedicine program quickly. Practice managers don’t want to learn by trial and error.


It’s not just about the technology

The biggest issue I see by far is that practices immediately focus on the technology. This often leads to two problems: (1) They either become overwhelmed by the plethora of options available and end up not pursuing telemedicine, or (2) they choose poorly and the technology quickly becomes unused. Consequently, I tell clients to ignore the technology that is available for starters. There are many more important things to consider in order to have a successful telemedicine program, and you will then be less likely to overspend or purchase equipment you don’t need or can’t use. Here are four items practices should carefully weigh before jumping into telemedicine by purchasing technology first.


1. Legal requirements

Because of the way telemedicine adoption is currently happening in the United States, practices must look into a host of legal requirements, especially as the requirements pertain to applicable state law. Although there are some exceptions, physicians usually must be licensed in the state where the treatment or diagnosis is being provided. Many malpractice insurers will now cover telemedicine, but that conversation must be had with your particular carrier so they can look at the various risks involved. As with other areas of healthcare, privacy, consent, and regulatory compliance must be thoroughly evaluated by a healthcare attorney. Additionally, I would strongly suggest that your proposed telemedicine program be reviewed by a telemedicine consultant and healthcare attorney to ensure it is vetted for potential fraud and abuse.


2. Reimbursement assessment

Currently, reimbursement (governmental and commercial) continues to be a barrier to telemedicine adoption in some (but not all) states. The type of telemedicine services you are proposing as well as the type of setting needs to be examined through the lens of the state(s) where services will be rendered, as well as the portfolio of applicable payers. Even though there may be restrictions that affect billing practices (and thus reimbursement), there are ways to get “paid” (e.g. subscriptions, etc.) for telemedicine services in lieu of reimbursement.


3. Market analysis

Telemedicine has many applications and uses, so the first task is to determine what the needs of your patients are and how telemedicine could address them. This step is a very detail-oriented process which will help identify potential telemedicine opportunities. A qualified consultant will help educate you about telemedicine technology applications which may apply to your potential goals, as well as educate you about predictors of success and best practices.


4. Feasibility study

The implementation of telemedicine services to your existing practice will certainly impact your operations. Some items to consider are the time you could save by implementing telemedicine, how you expect the telemedicine program to tie into your regular in-person practice, and what type of clinic hours you will devote to telemedicine.

There is no such thing as a standard telemedicine program. Consequently, it is extremely important to take the time to develop a telemedicine strategic plan first, as there are many nuances to consider as they relate to your particular practice. Hiring a consultant to help guide you in the right direction will be money well spent, especially given that such an endeavor will change your practice operations, including your marketing and financial operations.

Nick Hernandez, MBA, FACHE

Nick Hernandez, MBA, FACHE,, is the CEO and founder of ABISA, a consultancy specializing in strategic healthcare initiatives.

Since founding ABISA in 2007, his emphasis has been on developing and maintaining a strong relationship with physicians and identifying areas for business opportunity and support. The company’s client list includes physician groups, hospital systems, healthcare IT organizations, venture capitalists, private equity firms, and hedge fund managers.

Nick is a graduate of the United States Naval Academy and a former Captain in the U.S. Marine Corps. He holds MBA degrees in both Operations Management and Information Technology & E-Business Management from Wake Forest University. He is Board Certified in Healthcare Management and has been named a Fellow of the American College of Healthcare Executives.

He is a frequent guest lecturer and is often quoted in the national media. He has consulted with clients in multiple countries and has over 20 years of leadership and operations experience. Nick is a Subject Matter Expert in business strategy, practice management, telemedicine, health IT, and oncology.



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