Electronic Visits: Going Mainstream?

The AMA recently reported that they are in favor of reimbursement for telehealth.  Can you believe it? For those of us who have been toiling in the fields of Connected Health for many years, this is an amazing statement.  I dare say many of us never thought we’d be able to say or write it.  The Center for Connected Health is issuing a media advisory on this today.  In essence this represent a huge symbolic step in the adoption of telehealth.

A quick review of history:  until the late 90s, the Centers for Medicare and Medicaid Services did not reimburse for care unless patient and provider were in the same physical location.  They then dipped their toe in the water, largely due to pressure from politicians representing rural states, allowing providers caring for patients in ‘non-metropolitan statistical areas’ to bill Medicare for videoconferencing-based telehealth activities.  Earlier in the current decade, some commercial payers began reimbursing for ‘secure clinical message’ exchange between patient and provider.  These e-visits are reimbursed at the rate of ~$35/message.  With some minor exceptions that has been the state of remote health reimbursement for some time.

So for the AMA to suggest the payment for telehealth services should be broadened is wonderful news at first glance.  For at least the last 15 years, I’ve attended talk after talk where the same slide is shown with ‘barriers to adoption’ and tops on the list is ‘lack of reimbursement’.

But is it good news?

Perhaps you think I’ve gone soft – had too much time off this summer. How could it not be good news???

The caveat is that the AMA’s endoresement comes at a time when health care providers are being asked to engage in serious dialogue about the rising cost of health care and their responsibility to be part of the solution.

The reason that all manner of payers were reluctant to reimburse for telehealth all of these years is because they feared increases in utilization and redundancies would result.  I’m a dermatologist. What if  your primary care doctor sent me an image of your mole.  I look at it and decide that I really need to see you in person to be sure, but I bill for both the image review and the in-person visit.  If we simply reimburse telehealth on a fee for service reimbursement will those of us billing for services simply become part of the problem of rising health care costs?

Payment reform is in the air.  The day is not far off when insurers will be paying us in bundles and asking us once again to take financial risk for the care of our patients (capitation).  Connected Health advocates are bullish that remote care contributes to cost reduction by allowing for just-in-time care, allowing for spur-of-the-moment consultation and by minimizing redundancies and uneccessary office visits, emergency room visits and hospital admissions.  As an example, we’ve looked at the readmission rate for our heart failure patients on our telemonitoring program and it is about half the rate of non-monitored patients.

So maybe what the AMA should be advocating for is alternative care models to go hand in hand with alternative payment models, i.e. pay us for quality and outcomes and leave the delivery of services (in-person or remote) to us health care providers.

Kudos to the AMA for taking this important first step. But, we still have more work to do.

What do you think?