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Medicare will begin paying for more care delivered by telehealth next year, but restrictions could limit the growth in these virtual or remote visits.
The program pays for telehealth services only when provided in designated Health Professional Shortage Areas; additionally, patients must receive the remote care at a hospital, doctor’s office, or another approved ambulatory care site.
Dr. Robert Wah, president of the AMA
Physician organizations say it’s important that Medicare continues to add services that are covered when delivered via telehealth, but that greater adoption will not happen until payment and licensure issues are addressed.
According to the 2015 Medicare physician fee schedule, doctors can be paid for providing annual wellness visits, psychoanalysis, psychotherapy, and prolonged evaluation and management via telehealth.
Currently, about 10 million patients have received some form of telehealth services, according to the American Telemedicine Association. More than half (55%) of that is the remote reading of imaging by a radiologist, 24% is remote consultations, and 15% is remote monitoring. The remainder (6%) is comprised of miscellaneous and pharmacy services.
A recent survey of hospital, group practice, and home health executives found that most (84%) said that it was important or very important to develop their telehealth capability, but that reimbursement uncertainty was holding them back. Forty-one percent said they were not being reimbursed at all for telehealth, and 21% said that the rates were lower than for in-person services.
Only 6% said their programs were “mature,” according to the survey, which was conducted by Foley & Lardner, a law firm.
The American Medical Association has made expanded coverage of telehealth a priority. “We need coverage and reimbursement of telemedicine services and fewer restrictions in Medicare,” Dr. Robert Wah, the AMA president, said at the group’s interim policy meeting. “We want patients to use it if they need it. Lift geographic restrictions. Free up its use in alternative payment models.”
Telemedicine can increase access to care, especially in rural and underserved areas, according to Dr. Reid Blackwelder, board chair of the American Academy of Family Physicians. Currently, many family physicians are delivering health care remotely – by smartphone or Skype, for instance – but they often don’t get paid, he said.
Medicare requires that physicians use a G code to bill for health care provided remotely, and that additional documentation burden may mean that physicians don’t bill for it, even if they’ve delivered the care, Dr. Blackwelder said in an interview.
The AAFP would like to see a move away from those G codes, substituting a per member per month fee instead, he said.
Although Medicare pays the same amount for telehealth services as it would for the same services delivered in a face-to-face visit, not all private payers do so, which also dampens enthusiasm for telehealth, said Dr. Blackwelder.
According to the ATA, 22 states and Washington, D.C. require telehealth coverage to be on par with in-person visits.
Dr. Reid Blackwelder
Licensure is also an issue. Both the AAFP and the AMA support a model license plan developed by the Federation of State Medical Boards that would allow physicians to deliver services across state lines.
The Interstate Medical Licensure Compact was issued in September. According to the FSMB, 11 state medical boards have formally endorsed it: Texas, South Dakota, Wisconsin, Washington, Maine, Nevada, Alabama, Utah, Vermont, and Wyoming.
However, for licensure requirements to change, the compact must be enacted in every state.
Physician groups also want to ensure that telehealth services are given by “providers that have ongoing and established relationship with the patient,” said Dr. Blackwelder.
