Telehealth
Definition: Telehealth is defined as the exchange of medical information through electronic communication to improve a patient’s health.¹ Although often used interchangeably with “telemedicine,” telehealth encompasses a broader array of services and activities. Telemedicine solely describes the use of telecommunication to provide health care directly to a patient, while telehealth includes talking to a doctor live via phone or video chat, sending/receiving secure messages between providers, and remote monitoring of medical devices. Telehealth is one element of digital health, which is a broader term that includes “disruptive technologies that provide digital and objective data accessible to both caregivers and patients.”2 Examples of technologies that provide digital data include wearable devices and mobile health technologies.
Telehealth increased during the COVID-19 public health emergency (PHE) after the Office for Civil Rights at HHS allowed the use of common platforms such as Apple FaceTime®, Facebook Messenger® video chat, and Zoom®.3 However, with the end of the PHE in May 2023, HIPAA-compliant technology became required.4 Despite many changes to telehealth requirements and reimbursement through December 2024, telehealth remains an appropriate, and sometimes preferred, modality for patient care.5, 6
How it relates to ACO/PCMH: Centers for Medicare and Medicaid Services (CMS) is reimbursing providers for telehealth services, including services rendered from primary care providers, in addition to specialists.5,6,7 The majority of the services billable for telehealth can be conducted using audio and video conference applications. Furthermore, many clinical pharmacy services have shifted to telehealth as well, while others have remained in-person.8 The positive impact on patient care due to pharmacist interventions delivered via telemedicine has been well-documented.9 As utilization of telehealth services has increased, it is critical to note if patients are satisfied with care delivered through this medium. Patient satisfaction scores play a role in reimbursement as an important quality measure.6,,10, 11 A meta-analysis published in the British Medical Journal included 44 articles to evaluate factors associated with patient satisfaction in the context of telehealth and, overall, patients reported moderate to high levels of satisfaction with telehealth services, with some studies reporting patients preferred telehealth visits over in-person visits.11 Some factors associated with high patient satisfaction scores include improvement in behavioral outcomes, decreased waiting times, reduced travel time, and increased access to services.
Involved organizations/oversight: Despite the end of the PHE, CMS continues to reimburse for many telehealth services.6,7 Telehealth reimbursement among commercial payers is highly variable; however, many plans have broadened coverage and cover telehealth in some form. 11, 12 When considering billing for telehealth services, it is important to understand the specific state and federal regulations that may apply, such as required documentation elements.
References
1. Tuckson RV, Edmunds M, Hodgkins ML. Telehealth. N Engl J Med. 2017;377(16):1585–1592.
2. Meskó B, Drobni Z, Bényei É, et al. Digital health is a cultural transformation of traditional healthcare. Mhealth. 2017;3:38.
3. HHS. Notification of enforcement discretion for telehealth remote communications during the COVID-19 nationwide public health emergency. HHS.gov. Available at: https://www.hhs.gov/hipaa/for-professionals/special-topics/emergency-preparedness/notification-enforcement-discretion-telehealth/index.html
4. HHS. HIPAA rules for telehealth technology. HHS.gov. Available at: https://telehealth.hhs.gov/providers/telehealth-policy/hipaa-for-telehealth-technology#technology-considerations
5. Center for Connected Health Policy. Post PHE billing policy frequently asked questions. Cchpca.org 2023. https://www.cchpca.org/2023/05/POST-PHE-TYPE-OF-BILLER-FINAL.pdf
6. Centers for Medicare and Medicaid Services. List of telehealth services. CMS.gov. Available at: https://www.cms.gov/Medicare/Medicare-General-Information/Telehealth/Telehealth-Codes
7. HHS. Telehealth: What to know for your family. CMS.gov. Available at: https://www.cms.gov/files/document/c2c-telehealth-patient-toolkitdigital508c.pdf
8. Traynor K. Pharmacists turn to telehealth to meet patients’ needs. ASHP: Pharmacists advancing healthcare. Available at: https://www.ashp.org/news/2020/07/29/pharmacists-turn-to-telehealth-to-meet-patients-needs
9. Niznik JD, He H, Kane-Gill SL. Impact of clinical pharmacist services delivered via telemedicine in the outpatient or ambulatory care setting: A systematic review. Res Social Adm Pharm. 2018;14(8):707–717.
10. Robinson J, Borgo L, Fennell K, et al. The Covid-19 pandemic accelerates the transition to virtual care. NEJM Catalyst. Available at: https://catalyst.nejm.org/doi/full/10.1056/CAT.20.0399
11. Kruse CS, Krowski N, Rodriguez B, et al. Telehealth and patient satisfaction: A systematic review and narrative analysis. BMJ Open. 2017;7(8):e016242.
12 HHS. Private insurance coverage for telehealth. HHS.gov. Available at: https://telehealth.hhs.gov/providers/billing-and-reimbursement/private-insurance-coverage-for-telehealth#:~:text=Most%20insurance%20providers%20cover%20at,their%20coverage%20ahead%20of%20appointments
Contributing authors:
Armen Fstkchian, PharmD, BCPS, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Jarrett Bremmer, final-year PharmD candidate, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Sara Wettergreen, PharmD, BCACP, University of Colorado Skaggs School of Pharmacy and Pharmaceutical Sciences
Last Updated 2/1/2024 by Sarah M. Aldrich Renner, PharmD, BCACP