This post is sponsored by the American Telemedicine Association.
Payment for services has been one of the ongoing major impediments to the spread of telemedicine, but that is changing as payers see evidence of the cost savings telemedicine can provide.
Changes at the state, federal and commercial payer levels are the focus of several presentations at the upcoming meeting of the American Telemedicine Association.
When Investment Rhymes with Canada
Canada has a proud history of achievement in the areas of science and technology, and the field of biomanufacturing and life sciences is no exception.
“Historically, telemedicine services have been handled differently from in-person services by both Medicare and Medicaid,” said Alexis Gilroy, JD, a partner with the Jones Day law firm’s Washington, D.C. office. “The significant hurdle is that payers, likely concerned with increased costs from utilization, restricted payment for services provided via telemedicine arbitrarily while still covering such service when provided in-person. This has led to restrictions such as only allowing payment for telemedicine services when the patient is located in a rural area. But the tide seems to be turning.”
She points to the recently passed changes in Medicare Sustainable Growth Rate legislation as one indicator of change. The law specifically contemplates the use of telemedicine for post-acute care services as part of a bundled payment program. As the federal programs transition from fee-for-service (FFS) to shared savings and quality-based payment systems, this should also free providers to take advantage of efficiencies inherent in telemedicine delivery.
“Where I think the government ultimately goes will be related to where the evidence shows telemedicine provides savings,” said Scott Edelstein, JD, also a partner at Jones Day. “It seems to me that the federal government is punting the ball back to the providers.”
Private payers have been moving toward telemedicine services at a faster pace than the government programs. State-level telemedicine parity laws mandating equal payment regardless of where the patient is located drive some of this.
Health Benefit Consultants, Share Your Expert Insights in Our Survey
American Telemedicine Association The American Telemedicine Association is the leading international resource and advocate promoting the use of advanced remote medical technologies. ATA and its diverse membership work to fully integrate telemedicine into transformed healthcare systems to improve quality, equity and affordability of healthcare throughout the world. Learn more about ATA at AmericanTelemed.org.
“The private insurers are very positive about telemedicine and are covering services even in states that don’t have parity legislation,” said Gilroy. “They are incentivizing cost savings for those who seek services remotely as it often costs less than going to an urgent care clinic. Private payers are analyzing costs and seeing the savings telehealth can bring.”
Both attorneys see the move away from FFS as another reason reimbursement for telemedicine is growing and becoming easier. Basically, the alternative payment systems are giving the providers a lump sum of money and letting them work out how best to spend it within certain quality guidelines.
“There are also incentives for different providers to collaborate, especially concerning patients with multiple comorbidities,” noted Gilroy. “With telemedicine, the patient can see two or more providers in one day instead of needing to make multiple trips. Now the person can come in and have their specialty doctors collaborate amongst themselves more efficiently, while also bringing the patient into the mix.”
Telemedicine may also be primed to offer payment streams not tapped by traditional means. Consumers are already willing to pay premiums for such things as getting on airplanes sooner. Many consumers may be willing to pay extra to be able to receive some primary care services from home at any time. Large, self-insured companies are also looking to remote providers for services such as wellness programs that can keep their health costs down.
“There are many new reimbursement models being deployed as a result of the Affordable Care Act’s shift away from traditional FFS, which in turn is creating more opportunities for telemedicine services to be paid,” said Edelstein. “I think we’ll see increased interest in telemedicine as we continue to transition from FFS.”
These topics and others will be covered in “A Multi-Point Approach to Telemedicine Reimbursement and Legal Issues,” “Legal Issues in Telemedicine Business Models”, “Delivering Great Care, Getting Paid, and Avoiding Legal Problems” and other courses and presentations during ATA 2015.
Click here to register.
The American Telemedicine Association is the leading international resource and advocate promoting the use of advanced remote medical technologies. ATA and its diverse membership work to fully integrate telemedicine into transformed healthcare systems to improve quality, equity and affordability of healthcare throughout the world. Learn more about ATA at AmericanTelemed.org.
