Physicians push back on telemedicine reimbursement proposal

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Under CMS' proposal on virtual care reimbursement, Medicare would pay physicians $14 per virtual check-in, leaving many physicians concerned about patient payments since they already provide the service for free, according to a Kaiser Health News report.

CMS proposed the virtual care reimbursement in its update to the 2018 Medicare Physician Fee Schedule and Quality Payment Program. Under the proposal, Medicare would pay physicians $14 per virtual check-in versus the cost of a $92 patient visit. The virtual check-in would last about five to 10 minutes.

Physicians are concerned the Medicare payment would leave patients on the hook for a 20 percent cost-sharing charge, according to Kaiser Health News.

CMS said the Medicare payment would apply in instances where beneficiaries connect with their physician via audio or video applications to determine the necessity of an in-person visit. Nurse practitioners or physician assistants working with a physician may also conduct the virtual check-in. However, physicians and consultants said virtual check-ins could cover monitoring of patients trying to manage diabetes or another chronic illness, among various other services, according to the report.

The Medicare Payment Advisory Commission came out against the proposal in a Sept. 4 letter to CMS.

"Direct-to-consumer telehealth services, which allow the patient direct any-time access to clinicians for routine healthcare needs, appear to expand access, but at a potentially significant cost and without evidence of improved quality," the commission wrote. "Due to their greater convenience, these services are at risk of misuse by patients or providers. The Commission is specifically concerned that the proposed virtual check-ins and remote evaluation services are analogous to DTC services because they are patient-initiated, intended for routine care, have the potential for video and telephone use, and seek to expand convenience. Therefore, they have the same risk of excess utilization (and spending) without commensurate value to the program."

CMS Administrator Seema Verma said the virtual check-in proposal is part of the agency's initiative to allow physicians to spend more time with patients and reduce the paperwork burden physicians face regarding Medicare billing. According to the report, Ms. Verma and other CMS officials said they also believe the change would result in savings for Medicare due to fewer unnecessary office visits and addressing health issues as early as possible.

CMS has also made other telehealth proposals, including a proposal to pay physicians to review photos or videos submitted by patients via prerecorded "store and forward" video or image technology to evaluate conditions.

CMS seeks to implement the changes in 2019.

Julie Spitzer contributed to this report.


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