Telemedicine systems changed healthcare reimbursement models. The traditional fee-for-service approach which pays providers for every visit, procedure, test, and appointment regardless of patient outcome is unsustainable.
The fee-for-service approach emphasizes quantity over quality, rewarding healthcare providers for delivering more services without connecting these services to outcomes. This approach prioritizes immediacy of care over long-term and preventative care. The net effect is to create gaps in care while increasing costs for patients, insurers, and government agencies.
The Affordable Care Act (ACA), passed in 2010, contains many provisions meant to shift the quantity-based FFS system to a quality-focused outcomes-based system. These provisions focus on encouraging a change in the way healthcare is organized, delivered, and reimbursed.
eConsult virtual quality improvement technology enables PCPs to work remotely with a network of highly qualified telehealth specialists. An eConsult empowers PCPs to coordinate care more fully, ultimately leading to better outcomes and lower costs.
Moving to outcomes-based care lowers costs and improves quality
Healthcare providers who move from the FFS model to an outcomes-based model take on more financial risk since they must manage the entire episode of care. Technologies like eConsult telemedicine systems mitigate this risk by empowering PCPs to connect with on-demand specialists for their patients. With eConsults, PCPs work with patients who may not be able to follow-up directly with a specialist, have limited mobility, or do not require high-acuity specialist care.
eConsults alleviate stress on the entire healthcare system by reducing unnecessary specialist visits, improving access to patient care at the PCP level, and freeing up specialist time to focus on higher acuity patients. Our internal data reveals that for every specialist visit referral that is avoided, 3.5 total visits including follow up are ultimately saved.
Here are tangible ways that eConsults telemedicine systems help PCPs manage the entire episode of care:
- Enable rapid access to on-demand insight from specialists: The wait time to see a specialist in person can extend to weeks or even months. This delay compromises care and can impact patient outcomes negatively. eConsults deliver high-quality specialist insight to PCPs within 24 hours.
- Decrease the overall cost of care: Fewer specialist visits and reduced wait times for specialist feedback means the overall cost of care is lower for the patient, payer, and at-risk provider. Now, the PCP can put the care plan in place with specialist guidance and conduct follow-up care within the primary care setting. eConsults enhance the care offering and capture revenue that would otherwise be spent on unnecessary specialist referrals.
- Improve outcomes of care: Increased access to care via eConsults contributes to better patient management. This improved continuity of care by decreasing in ED visits and hospitalizations by reducing the number of acute events. Patients benefit by having their care needs satisfied much quicker and avoiding unnecessary travel and missed work associated with a standard specialist referral.
- Expand clinical capabilities: eConsults replace unnecessary specialist visits, allowing specialists to focus on patients that truly need their care. PCPs can operate at the top of their license. When a specialist visit is appropriate, the PCP with specialist guidance can provide more patient care oversight and/or interim care planning advice while patients wait to see the specialist. By connecting PCPs to on-call specialists, eConsults allow providers to expand their capabilities by treating lower acuity patients and billing them effectively within the primary care setting.
How eConsults Increase Quality of Care
More than 70% of routine clinical referrals can be avoided by eConsults, enabling PCPs to rapidly address concerns previously referred to specialists. Rapid access to specialist oversight is a fundamental ingredient of outcomes/risk-based care. It allows PCPs to manage chronic conditions and address new issues from diagnosis to the final care plan.
Payers understand that telemedicine systems improve outcomes
Government agencies and private insurers increasingly allow PCPs to leverage new telehealth tools which include eConsults and processes. This was the case even before COVID-19 created barriers to doctor visits and forced patients to postpone follow-up care.
The shift from fee-for-service to outcomes-based care accelerated with the Affordable Care Act (ACA), which contained many provisions that encouraged quality over quantity in healthcare. This included covering new telehealth and virtual quality improvement services.
eConsult telemedicine systems add value all stakeholders
The traditional fee-for-service model incentivizes physicians and healthcare systems to focus on quantity over quality. This can have a detrimental effect on patient outcomes and the overall cost of care. It’s a system that has increased healthcare costs and reduced access to specialists year after year for decades.
eConsults provide a secure, scalable, and modern way to improve outcomes and reduce costs. eConsult technology benefits everyone from providers to insurers to patients.
With government agencies and both private and public health insurance providers emphasizing outcomes/risk-based care over fee-for-service, PCPs can and should focus on expanding their capabilities to address the entire episode of care.
eConsult technology does this by reducing unnecessary specialist referrals, cutting down long wait times for low acuity patients, and empowering PCPs to create specialist-guided care plans more quickly. With on-demand specialist guidance through an eConsult telemedicine system, PCPs can manage the patient’s entire episode of care, improve patient outcomes, and better control associated costs.