Regulations and restrictions on reimbursement have traditionally been a barrier to the widespread adoption of telemedicine. But 2018 brought good news for practices interested in telemedicine as a cost-effective treatment option; those barriers are starting to fall.
The new federal budget deal, signed off on by Congress in February, allows for wider coverage for telemedicine services than we’ve seen historically, and it’s likely that these changes are only the beginning.
Becker’s Spine Review says telemedicine will grow to a $57.92 billion industry by 2020. The Centers for Telehealth & e-Health Law says 96% of all large employers will offer their employees telemedicine coverage of some type this year. The article quoted a CEO as saying; “Employers are recognizing that traditional cost control techniques alone aren’t able to reduce costs to the point where they are no longer a drain on the bottom line.”
No matter how popular the service is becoming, most medical practice providers want to know more about telemedicine reimbursement before adopting the technology.
This article looks at the current state of telemedicine reimbursement and makes some predictions about what lies ahead.
New Telemedicine Laws Signal Better Reimbursement Options
Housed within the Congressional budget this year is new bill designed to make telemedicine a viable part of more clinical practices. That’s because the technology has proven its cost-effectiveness and ability to expand access to clinical care. Given that reimbursement continues to decline and that physician shortages are a growing concern, it seems that telehealth services are finally at a tipping point.
In February, Congress came together with the President to sign off on the new budget. Within the budget was a new law tied to telemedicine. It was called The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017.
CHRONIC sought to extend home care to patients with multiple chronic illnesses. Within the law were several provisions designed to provide more reimbursement for telemedicine. Specifically, the new law will:
- Expand telemedicine coverage for stroke victims in rural areas.
- Improve home care for dialysis patients with telemedicine.
- Allow Medicare Advantage plans cover telemedicine service as a standard benefit.
- Provide Accountable Care Organizations (ACOs) the reimbursement needed to expand telemedicine services.
The new law states:
Telehealth may have the potential to replace some face-to-face office visits, reduce emergency room visits, and prevent hospitalizations. Telehealth may also keep beneficiaries in closer, more consistent contact with providers.
Samantha Burch, the Senior Director of Congressional Affairs for HIMSS praised the legislation and suggested:
Passage of the CHRONIC Care Act telehealth provisions marks an important step forward for connected care. Congress, HHS and the healthcare community have much more work to do to modernize Medicare to increase use of remote patient monitoring (RPM) and set the stage for realizing the potential of the many innovative technologies coming down the pike.
The only bad news was that this law was tucked within the confines of this year’s contentious two-year budget. However, telemedicine advocates suggest that, while Medicare is lagging behind, the door has been forever opened.
Telemedicine – and the Future State (of Reimbursement)
The Centers for Medicare & Medicaid Services (CMS) continued to loosen the purse strings for telemedicine this year, by “paying appropriately for service that maximize technology. (Click here to read the latest rule changes.) The agency made a few revisions to telemedicine reimbursement for 2018, including:
- Expanding allowable telemedicine reimbursement.
- Expanding the list of allowable types of telehealth services.
- Expanding telemedicine in diabetes prevention programs,
Currently, 48 states allow for telemedicine reimbursement under Medicare. While these are all good signs, what about private payers?
Many insurance carriers cover telemedicine services. Cigna Healthcare has been paying for what they call “virtual house calls” since 2007.
We reported a few weeks back that 34 states currently require private insurance carriers to provide coverage for telemedicine. States like Oklahoma have loosened restrictions on how doctors can use the technology. Don’t forget that CMS reimburses for telemedicine at the same rate as for face-to-face visits.
Speaking of CMS, an article in the American Academy of Orthopaedic Surgeons (AAOS) Now reminds us that in 2016 CMS eliminated geographic restrictions for follow-up consults with post-op hip or knee replacement patients. So, orthopedists can now receive reimbursement via bundled payments by using telemedicine.
One last piece of good news is that there are more than 30 states that have passed telemedicine parity laws. This means that if the payer covers face-to-face visits, they must reimburse telemedicine at the same rate. In fact, CTel says that there were more than 200 telemedicine-related bills introduced in 44 states last year – so you likely haven’t heard the end of telemedicine parity in reimbursement.
Does Telemedicine Pay?
“Congress’ desire to identify additional appropriate uses of telehealth and to reevaluate the current Medicare coverage requirements, CMS’ expansion of the list of telehealth covered services (albeit rather slowly), and the fact that Medicare and Medicaid payments for telehealth services are at an all-time high indicate that telehealth reimbursement will continue to improve in 2018 and beyond.”
If the original question was – does telemedicine pay – the answer is certainly, “Yes.” But whether CMS or your payers cough up the cash for telehealth services, the technology is already more cost effective in many cases than the traditional on-site visit. Telemedicine has already proven to cut costs and improve patient volumes in the medical practice.
In fact, a new study predicts that in 2018 the volume of health systems that will be using telemedicine to treat patients is doubling from just two years prior. Hospitals see the benefit of improving access to care while cutting costs. Patients see the value of the convenience of staying home to see their doctor. We know the statistics show that telemedicine allows clinical providers to better monitor post-surgical wound care while reducing readmission penalties.
So, it appears that telemedicine is poised to finally reach the full potential that the technology promised us decades ago. With reimbursement shifting and patients clearly embracing the technology the only thing holding your practice back – is yourself. The OrthoLive team is standing by to show you our affordable and effective telemedicine service is. Contact us for a demo today.
