New bill would expand Medicare patients ability to utilize telemedicine

Last month, a bipartisan bill aimed at boosting Medicare’s coverage of telehealth services was introduced by Sens. Cory Gardner (R-CO) and Gary Peters (D-MI).  

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If passed, the legislation-known as the Telehealth Innovation and Improvement Act-would expand access to healthcare in both rural and urban areas by paving the way for Medicare to cover additional telehealth services.

“Telehealth helps improve access to healthcare providers and will be instrumental in providing primary care services in local communities,” Osman Farooq, MD, an internist in Longwood, Florida, says.

For example, at some providers, patients have the option to see a healthcare professional from the comfort of their own home, as virtual appointments allow the convenience to receive immediate personalized healthcare.

Currently, Medicare covers limited telehealth services. The new legislation would require CMS’ Center for Medicare and Medicaid Innovation (CMMI) to examine whether delivery reform initiatives, such as ACOs and bundled payments, can demonstrate how telehealth and remote monitoring services can help providers achieve program goals. 

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The CMMI would evaluate the tested telehealth service for cost, effectiveness and quality of care. If one of the evaluated models succeeds in testing, eligible hospitals would be covered throughout Medicare.

Is it enough?

Not everyone thinks the legislation introduced is powerful enough. 

James Wantuck MD, chief medical officer and co-founder of PlushCare, a telehealth urgent care provider, says legislators at all levels of government and in all parties, are moving in the right direction, calling the bill a small step forward, but one with large limitations.

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“The bill requires CMS to test telehealth in the Medicare population, but requires it to do so on a limited number of diseases. Meaning, it’s going to take years before studies on its cost effectiveness are available,” he says. “Telehealth is moving at the fast pace of technology and CMS moves at, well, the pace of the government. Medicare is falling behind the private payers and those who operate independently of third-party payers altogether.”

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Ultimately, Wantuck notes, what’s needed is a bill that recognizes telehealth’s immediate effectiveness and views it as something that doesn’t needs to be tested.

“Telehealth, at least in its most common form-live real time audio visual communication-isn’t a new medical device or drug, it’s merely a method of completing the same interaction [between doctor and patient],” he says. “Did we need to test office visits when we abandoned house calls 50 years ago? The bottom line is that telehealth improves access to healthcare, and, if you believe that greater access to physicians for rural and elderly Americans will lead to improved health, then reimbursement for telehealth will provide that.” 

Impact on PCPs

Gus Crothers, MD, medical director of clinical personnel for Grand Rounds, a San Francisco-based company that matches health care providers with patients, said that since the bill is specifically targeting “eligible hospitals,” it would only impact primary care physicians who were employed by those hospitals and who were chosen to participate in any telehealth pilots or services that the hospitals wanted to offer.

“However, since most telehealth utilization to date has been for low-severity, primary-care-sensitive conditions (UTI's, sinusitis, upper respiratory infections, etc.), it is reasonable to assume that primary care physicians might be an early use case for Medicare ‘eligible hospitals,’ as well,” he says.

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Studies have shown that PCPs are already very accustomed to providing healthcare over the phone. Most thorough primary care physicians spend up to an hour or more per day returning patient phone calls to answer questions, review test results and get updates on a patient’s situation.

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“The main problem is that PCPs don't currently get paid for this work, so it gets marginalized and crammed between all the face-to-face visits that fill up a PCP’s schedule,” Crothers says. “If this legislation succeeded in creating reimbursement streams for effective, high-quality telehealth services for PCPs, then they could expect to see their schedules shift to include virtual visits throughout the day. Hopefully, these visits would displace and prevent the need for many of the low-value service utilizations that contribute to healthcare waste.” 

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Wantuck feels the average primary care physician doesn’t care about the bill, and won’t go to the trouble of investing in a telehealth program when he/she is confident that reimbursement will be lower or nonexistent-especially with legislation that has very specific guidelines on what counts and what doesn’t.

“Telehealth is on the average PCP’s radar, but is often far off in the distance, as they’re far more concerned with their already overwhelming array of responsibilities,” he says. “Alternatively, hospitals and larger practices have the resources to implement a telehealth program and it may be good from a PR perspective, but not much more than that.”