Medicare Slow to Take On Telemedicine

Will Telemedicine Improve Health Care?

Telemedicine Medicare
Medicare may consider paying doctors to care for you over the phone. AN HOOTON/Science Photo Library/Getty Images

What is telemedicine? Telemedicine is care that you receive by video conferencing with your doctor. A phone call is not enough. There must be both audio and visual communication between you and a healthcare professional for it to count.

Medicare provides health insurance to over 55 million Americans but less than one percent of them have accessed telemedicine services. For Medicare Part B to pay for telemedicine services, you first need to live in a qualifying rural community.

Secondly, you need to utilize those services from a community mental health center, dialysis center, doctor's office, health clinic, hospital or skilled nursing facility. Telemedicine services will not be covered from your home. With these restrictions, the convenience of telemedicine quickly falls to the wayside.

Many seniors have a difficult time getting to and from the doctor's office. Not only can transportation be difficult but they may be too ill or frail to travel at all. More than four percent of people no show their appointments.

In a perfect world, the doctor would go to the patient but not all doctors offer house calls. It is not that they do not want to provide the service but that the volume of patients they are expected to see limits their ability to travel away from the office. Medicare has initiated a pilot program to incentivize doctors to offer more home visits.

Telemedicine is a potential way for patients to still be "seen" by the doctor and get the care they need.

While video conferencing may not be appropriate in all situations (many medical conditions require hands-on evaluation), it is a potential way to decrease health care costs.

When patients are able to access the preventive care they need or receive care at the beginning of an illness, they are less likely to need to go to the hospital.

Hospital costs, as you know, can get quite expensive. An emergency room visit without an overnight stay costs $1,233 on average. Costs grow further if the patient is admitted to the hospital.

While Original Medicare limits payment for telemedicine, Medicare Advantage plans and Affordable Care Organizations (ACOs) operating under Medicare have the option of offering telemedicine visits. To date, only two Medicare Advantage plans offer telemedicine services, Anthem and a University of Pittsburgh Medical Center health plan.

Proposals are being made to expand telemedicine for Medicare but concerns have been raised about its cost effectiveness. Is there proof that telemedicine will improve care? Will people overutilize telemedicine because it will be so easy to access? Will this increase the number of visits overall? Will telemedicine end up costing Part B more in the long run?

Medicare sets the stage. Until Medicine adopts telemedicine more broadly, many people may lose opportunities for health care.

Sources:

Caldwell N, Srebotnjak T, Wang T, Hsia R. How Much Will I Get Charged for This?” Patient Charges for Top Ten Diagnoses in the Emergency Department. PLoS ONE. 2013; 8(2): e55491. doi:10.1371/journal.pone.0055491

Chronic Conditions Data Warehouse. Medicare Enrollment by Age Group, 2004 - 2013. https://www.ccwdata.org/web/guest/medicare-charts/medicare-enrollment-charts. Published April 25, 2015.

Comstock J. Why less than 1 percent of Medicare beneficiaries use video visits. MobiHealth News. http://mobihealthnews.com/44731/why-less-than-1-percent-of-medicare-beneficiaries-use-video-visits/. Published June 25, 2015.

Medical Group Management Association. MGMA report: Medical practices designated as “better performing” emphasize cost management, productivity, and patient satisfaction. http://www.mgma.com/about/mgma-press-room/press-releases/2007-2012/medical-practices-designated-as-better-performing%E2%80%9D-emphasize-cost-management-productivity-and-pati. Published October 27, 2014.

Medicare.gov. Your Medicare Coverage: Telehealth. https://www.medicare.gov/coverage/telehealth.html. Accessed August 17, 2015.

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