This summer, Rhode Island became the 31st state to require payment parity for telemedicine services. The new law, the Rhode Island Telemedicine Coverage Act, requires commercial health plans to reimburse for telemedicine-provided services at the same rates at which they pay for in-person visits. Read more
In one of the first published studies to measure exactly how often telemedicine is utilized, Harvard Medical School researchers discovered that telemedicine use among Medicare patients grew roughly 28 percent each year between 2004 and 2013. This rise is even more impressive in light of Medicare’s restrictive reimbursement policy: Medicare only pays for telemedicine visits if the patient lives in a rural area and travels to a clinic for the telemedicine visit. Read more
Just this week, the Centers for Medicare & Medicaid Services (CMS) announced a final rule proclaiming that telemedicine for Medicaid home health services may qualify for reimbursement. CMS urges individual states to determine specifically the types of telemedicine that will be authorized. Read more
In a move aimed at increasing reimbursement for telehealth services, the American Telemedicine Association (ATA) and American Medical Association (AMA) are working together to suggest new CPT codes to the Centers for Medicare & Medicaid Services (CMS) later this month. If accepted, the new codes would allow CMS to recognize and reimburse more telemedicine services. Read more
As we face a future filled with increasing health care needs and a predicted shortage of physicians, it becomes clear that the old paradigm of medicine—namely, time-consuming office visits—will no longer suffice. Newer technologies, such as telemedicine, have the ability to address these needs by offering high-quality, cost-effective, and time-efficient care—but only if we allow it.
Unfortunately, science and patient demands evolve more quickly than legislation, and our current structure is hindering a more widespread and effective use of telemedicine. Read more
Patients in rural areas and with limited transportation may welcome telemedicine, but what about the doctors?
It appears that physicians everywhere are also embracing this technology. A recent nationwide poll, conducted by QuantiaMD and American Well, reveals that 57 percent of primary care physicians are interested and willing to conduct telemedicine visits with their patients (1).
To better understand this response, let’s examine the context. As revealed by the survey, doctors are spending increasing time on non-reimbursable phone and email communications with patients. The average family doctor devotes nearly 4 hours per week on phone calls and emails, and each phone call alone costs roughly $20 of the physician’s time.
In this situation, it makes sense to replace non-reimbursable activities with billable telemedicine hours. Read more
You might think that the passage of the Affordable Care Act in 2010 and the resulting opportunities for telemedicine would have led to widespread telemedicine usage to increase access to healthcare while reducing costs, but the reality is that reimbursement from government agencies—such as Medicare—has fallen far behind the rhetoric. And when good intentions aren’t backed up with adequate funding, progress can become slower than molasses.
Telemedicine has certainly grown steadily, but the impact has been felt more significantly among those with private insurance that provides reimbursement for telemedicine visits. Among Medicare beneficiaries, less than 1% have coverage for telemedicine (1). And of those who are fortunate enough to enjoy such coverage, particularly those in rural areas, Medicare often requires the beneficiary to already be at a clinic. So much for making healthcare more convenient. Read more
“Is your cucumber bitter? Throw it away. Are there briars in your path? Turn aside. That is enough.”
Marcus Aurelius, Meditations.
For an industry full of innovators, there’s a distinct lack of innovation in overcoming the reimbursement issue. I believe this is largely because we’ve trained ourselves to continue focusing on reimbursement, rather than discovering how to make the lack of reimbursement work for us or on creating a new model of telemedicine that makes reimbursement an afterthought.
If you believe telemedicine won’t expand until reimbursement is solved, why are any of us involved in Telemedicine? (I assume it’s to improve healthcare, which means we shouldn’t let reimbursement stop us.)
This is not to say that reimbursement is not impo Read more
As with last month, this is largely geared to updates about legislation along with reminders about the upcoming Fall Forum conference in Palm Springs, CA, which I’ll have to consider as I live out Orange County.
This month’s takeaways are a little more subdued than last month which had some pretty big news (see here). The ATA had just done a survey on online consultations and had over 500 respondents.
1) 45% of respondents are using telemedicine TODAY. This is fantastic news and, in my mind, is possibly underreported because, as Mr. Linkous and Mr. Capistrant pointed out on the last call (and pointed out in our 3 Things from last month), nearly every institution is already using some form of telemedicine and the boards don’t realize it.
2) Specialty Care and Behavioral Health were the leading segments. Not terribly surprising, as specialty care often needs to use leading edge tools to leverage resources for special care, and behavioral health lends itself well to an old-school videoconferencing set up (patient and doctor meet via video), leading to less push-back on its use while providing maximum benefit to both patients and providers. The industry will have to really work, I think, to make sure providers and CDOs are aware of the more specialized applications and the benefits to be had. Telemedice will not yield a large harvest if we only pick the low-hanging fruit. As if to prove that point:
3) 77% use video, 57% use audio and 28% use medical peripherals. Just over a quarter are using peripherals, while three times that are using video. Being at a video-primary solution provider: Yay! Being a proponent of telemedicine as a whole: We can do better. Even the video-primary medical solutions offer a lot of specialized or integrated offerings that provide more than just adding a visual element to distance care. Again, the question is, how do we get this to the doctors and CDOs?
4) Of the 55% of respondents that replied they are not using telemedicine today, 75% plan to implement it very soon. I present that as Exhibit A to the tipping point naysayers…although I concede that if you responded to a survey about telemedicine from the American Telemedicine Association, you’re probably already predisposed to an interest in telemedicine. Having said that, interest in telemedicine has been on the rise, and 75% of that growing crowd being interested in giving it a shot can only be a good thing.
4) Mr. Linkous pointed out something toward the end that I assumed would be a primary driver (or at least remove an obstacle) but assumed would take several more years: Private insurance is increasingly taking the lead in pushing telemedicine. I’ve been noting that the reduced cost/better outcome/reduced readmissions scenario HAS to eventually turn private insurance into champions of telemedicine. Amongst the names he mentioned were Kaiser Permanente, Aetna, WellPoint, and others.
