Virtual care seems ideal for treating frail elderly people — but there are few business models employing virtual care because payers don't cover it.
It's easy enough for a doctor on an app to prescribe a birth control pill or an antibiotic. But try getting one to virtually examine your sick mom in a nursing home. Chances are, she'll end up instead being sent to the hospital, where bad problems often get worse.
In medicine overall, telemedicine usage is growing; private insurance claim lines for virtual care grew 53 percent from 2016 to 2017, according to a recent report from FH Healthcare Indicators. Increasingly, employers are offering employees access to direct-to-consumer companies like Teladoc and Doctor on Demand, where patients can reach an on-call doctor virtually whenever they need.
He cited a host of reasons: Varying reimbursement policies depending on whether elder patients are covered by Medicaid, Medicare, both, or private insurance; providers and payers not fully embracing value-based care payment models; and, occasionally, patients' and practioners' discomfort with the technology.
Call9, which contracted with nursing homes to treat patients virtually on-site, would have benefited from the Reducing Unnecessary Senior Hospitalizations Act of 2018, CEO Tim Peck told POLITICO after the company shuttered. However, many of Call9's partners still operate on a fee-for-service basis, instead of rewarding the value of care, an idea that's popular but hasn't expanded throughout health care yet.
Only about 10 percent of nursing homes keep physicians on site around the clock, said Christopher Laxton, executive director of the Society for Post-Acute and Long-Term Care Medicine, a professional organization. They're among the hardest places to staff adequately, Laxton said. "It's hard work, it's not very well paid. ... the people that work at it are frankly sort of mission driven.
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