Original Publish Date: October 11, 2016
Telemedicine is on the cusp of a healthcare revolution. But we have more to do to enable all people, no matter age, location or their health insurance coverage, to be able to utilize the technology that is available.
Private insurance and Medicaid Managed Care Plans have adopted it. The last frontier are those who are covered under Medicare plans. CMS (Centers for Medicare & Medicaid services) is slow to make the changes that in 2014 were implemented for a 4-year phase-in, until all patients would be covered.
In the news today the American Association of Family Physicians is taking CMS to task for elements of the 2017 Medicare physician fee schedule (the actual schedule should come out in November of this year) that hinder Telemedicine reimbursements for store-and-forward, observational care and ED services. Store-and-forward (electronic communication sent to an intermediate site verifying the integrity of the message).
AAFP Board Chairman Robert Wergin, MD, wrote in a 56-page letter to the Centers for Medicare & Medicaid Services earlier this month.
"In light of the growing amount of evidence suggesting the effectiveness of various forms of Telehealth services, the AAFP supports revisions to policies that create unnecessary barriers to the responsible and appropriate use of Telemedicine services," You can access the letter on the AAFP website.
Chief among the complaints is CMS’ requirement that a patient must be in a telehealth-origination site to receive reimbursable care. That basically eliminates asynchronous or store-and-forward platforms. Originating sites, as defined by CMS are physician offices, hospitals, CAHs, rural health clinics, FQHCs, SNFs, CMHCs, or hospital-based or CAH-based renal dialysis centers.
Wergin wrote: “Standards of care are impacted by current technology capabilities, but should not be dictated by arbitrary policies or statutes that become antiquated as a result of improvements in technology capabilities.”
We need our government agencies to change legislature and policies to keep up with the technology available for healthcare. We can no longer keep antiquated systems that do not sync with current technology. We need to all do our part and work with policy makers to affect change.
Wergin also criticized CMS for its plans to deny new CPT codes related to observation visits and emergency department care. Again, the denying of new CPT codes go hand in hand with not matching up to the antiquated statues. Its time to change the statues to keep up with current healthcare technology and needs.
We are all aware that we have a shortage of primary care physicians. Doctors tend to cluster in large cities, leaving smaller towns and rural area patients no choice but to have to travel to get medical care. Wergin’s letter to CMS urges broader adoption of reimbursable telemedicine codes. With that adoption, patients with chronic conditions that require frequent in-office visits will likely experience greater health outcomes and a better experience with the healthcare system.
Where CMS fails to move forward Medicaid has. A recent telemedicine policy report from the American Telemedicine Association (ATA) has an excellent, in-depth analysis of state Medicaid coverage for telemedicine.
Here are some of the key findings:
While the ATA report shows there’s still room for improvement, the nation is trending toward broader coverage for telemedicine.
As you’re researching your state Medical policies, also keep in mind that your state Medicaid handbook may not yet reflect the most recent policies passed. Some programs haven’t quite caught up yet to the flood of new telemedicine policy. That’s why it’s always best to contact your state Medicaid program and verify the telemedicine guidelines as you’re getting started.
It’s time Medicare moves forward as well. Let’s all do our part to help make it happen before 2018.
For the full report from the Department of Health and Human Services (an arm of CMS), go to https://www.gpo.gov/fdsys/pkg/FR-2016-07-15/pdf/2016-16097.pdf
Cindy has been in the healthcare arena for over 18 years, largely in the capacity of CFO overseeing 15 assisted living facilities. She is currently the Regional Director for Go Telecare, a Telehealth and Medical Billing Company and can be reached at 360-909-7472 or cindy.lamar@gotelecare.com. See the Go Telecare web site at www.forewardhealthcare.com.