Telehealth grapples with the ‘R’ word

November 12, 2014 in Medical Technology

The first thing any provider considering telehealth practices and technologies must thoroughly grasp is the payment model.

Simply knowing your options about what kind of reimbursement is available is the biggest hurdle.

“If you can understand that,” said Alexis Gilroy, a healthcare attorney with the firm Jones Day, “then you can navigate and build the right kinds of products and processes.”

Gilroy and a panel of industry experts will expound more on issues related to reimbursement, telehealth and mobile health at next month’s mHealth Summit 2014.

Medicare only reimburses for telehealth that is conducted in real-time — which leaves out much of the telehealth conducted by pathologists, radiologists and dermatologists, who usually review images on a “store-and-forward” basis, Gilroy said.

In addition, 22 states have passed “parity” laws prohibiting private payers from denying claims for services provided via telemedicine, Gilroy said, but such legislation in most states defines telemedicine as real-time video and audio communication between patient and provider.

Today’s Medicare regulations also require that the real-time telehealth visits be conducted while a patient is at a medical facility. This creates a situation where sick, home-bound patients must first be transported from their homes — sometimes by ambulance — to receive teleheath care, Gilroy said. This takes a financial toll on the patient and the healthcare system.

Last July, Reps. Mike Thompson (D-Calif.) and Gregg Harper (R-Miss.) introduced the Medicare Telehealth Parity Act of 2014, to improve the reimbursement situation for telehealth. The bill is currently in House committees for review.

The Telehealth Parity Act proposes to expand telehealth coverage in phases. The first would expand coverage for certified diabetes educators, speech language therapists, audiologists, respiratory therapists, occupational therapists and physical therapists. Phase two would add coverage for video conferencing and store-and-forward technologies in counties located in metropolitan statistical areas with populations of 50,000-100,000. Then phase three would extend the same for video conferencing and store-and-forward technologies for counties located in metropolitan statistical areas with populations over 100,000.

Many government and industry observers think the bill has a good chance of passing, Gilroy said, because Congress is beginning to understand how much telehealth can save money and help patients.

Some providers, in the meantime, are absorbing these costs because telehealth visits are creating better outcomes for patients; in the long run, this saves money for hospitals if they are participating in a value-based reimbursement program.

“Ultimately,” Gilroy said, “it’s about the patient.”

The mHealth Summit 2014 runs from Dec. 7-11 at the Gaylord National Resort and Convention Center just outside Washington, D.C. Register here.

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