Although telehealth may be the newest darling child in the world of patient care (it is widely recognized as a convenient, effective complement to traditional forms of medical delivery), there is new data demonstrating that it has not been as expansively used as its convenience reflects, at least within government-funded care.
Providers agree telehealth can improve quality of care
The U.S. Government Accountability Office (GAO) released a report earlier this month showing that less than 12% of the following were treated via telemedicine between 2014 and 2016: Medicare and Medicaid beneficiaries, and patients seen at the Veterans Administration and the U.S. Department of Defense. Additionally, less than one percent of Medicare enrollees used telehealth services during that time period.
The GAO’s report was culled from surveys taken by healthcare providers, including comments that pointed to “cost increases or inadequate payment and coverage restrictions” as reasons for not implementing telemedicine platforms in their practices. This despite labeling telehealth and remote patient monitoring as “a significant factor” in the effort to “improve or maintain quality of care.”
Is restricted coverage restricting telehealth implementation?
The study was carried out under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The bottom-line issue that seemed to get in the way most frequently for providers when considering telehealth: “Medicare’s restrictions on the types of services covered by the [telehealth] program have prohibited its broader use. Regarding remote patient monitoring, officials from another provider association stated that Medicare’s valuation methodology for services results in low payment rates for remote patient monitoring, which these officials said remains a principal barrier to the use of these services.”
The GAO study found that one of the “coverage restrictions” providers referenced as interfering with widespread use of telehealth include the requirement for an “originating site,” Medicare’s prohibition against telemedicine services rendered in an urban area or in a residence. Currently Medicare will cover remote healthcare services provided in rural areas only.
Tens of thousands claims missing originating site info
The Medicare Payment Advisory Commission (MedPAC) released a report last year revealing that a little over half of the 175,000 telehealth claims covered in 2014 failed to include an originating site. That omission on its own does not necessarily mean the claim payments will be reversed (though the Centers for Medicare & Medicaid Services [CMS] is presently reviewing the MedPAC findings), but nearly half of those claims “were associated with beneficiaries living in urban areas,” and further, one of the providers heavily using telemedicine (around 2,000 visits in just that year) exclusively saw patients residing in urban settings.
However, the rural-exclusivity may not be a fixed thing in Medicare’s future. The report states: “While Medicare currently uses telehealth primarily in rural areas or regions designated as having a shortage of health professionals, in the future emerging payment and delivery models may change the extent to which telehealth and remote patient monitoring are available and used by Medicare beneficiaries and providers in other areas.”
And yet, the CMS does not currently possess convincing projected data for urban expansion, at least with Medicare. The report goes on to explain: “According to the Congressional Budget Office, the financial impact of expanding telehealth and remote patient monitoring in Medicare is difficult to predict—it may reduce federal spending if used in place of face-to-face visits, but it may increase federal spending if used in addition to these visits.”
Telehealth not immune to pragmatic snags
Perhaps unsurprisingly, another frustrating piece getting in the way of providers choosing the telehealth option more often is the infrastructure foundation to any remote patient-provider connection: “access to sufficiently reliable broadband internet service.”
CMS’s alternative payment models in progress should bolster telehealth
CMS is illustrating its commitment to telehealth adoption via modernized payment and service delivery approaches, such as Episode Payment Models, Bundled Payments for Care Improvement models, and Accountable Care Organizations (ACOs), all having the central goal of lowering expenses incurred in Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP).
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