In part one, I laid out my thoughts on barriers to entry centered around how we pay for telemedicine and some policy issues that exist. In part two, I want to discuss potential solutions.
Possible solutions to expand adoption
Expand services insurers reimburse
Granted, many payers (health care insurance companies) do pay for telemedicine services. But insurers decide on the level of reimbursement, so this can vary widely.
Some payers follow the standards set by Medicare, which reimburses only for certain services provided to patients in underserved areas. Those services, such as the management of chronic conditions, annual wellness exams, and behavioral counseling, must be conducted face-to-face via video in an approved site, such as a hospital, doctor's office or clinic. Few payers will reimburse fully for direct to consumer telemedicine wherever the patient resides.
Medicare and other payers also limit telemedicine’s reach into many urban environments. Additionally, the requirement that the patient be located in an approved facility (medical clinic), further limits the true possibilities of telemedicine – convenience and lower costs.
Naturally, there are concerns about possible fraud and abuse, but expansion of services covered and allowing more flexibility in where the visit can take place could incentivize patients, caregivers, and providers to be more available, have better compliance with the medical plan of care, and possibly even lead to lower costs. It is a step closer to making the easy thing to do, the right thing to do.
Pay the same for telemedicine as for in-person visits
Providers, caregivers, and patients realize that telemedicine has great promise and opportunity to make a positive impact. It has been shown that many conditions can be managed safely and effectively via virtual connectivity.
If the outcomes are the same, why isn’t the payment? While not every disease process and condition can be managed remotely, many can. It is worth the conversation to pay a similar rate as face to face care.
Thirty-four states have passed parity laws. This helps ensure payers reimburse for telemedicine visits at the same rate as they would for in-person visits. That still leaves 16 states that have not passed such laws. What better way to incentivize providers and patients to consult over video than to pay the same as you would if the visit took place in the office?
Stay tuned for part three in which I present my remaining thoughts and solutions.