The bill furthest along, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2017, aims to improve at-home care, increase Medicare Advantage flexibility, give ACOs more options and expand telehealth capabilities for stroke and dialysis patients. The CHRONIC Care Act passed the U.S. Senate in September.
Here are five things to know about telehealth reimbursement.
1. Under current Medicare guidelines, the government payer does not recognize remote medical consultations as equivalent to an in-person consultation, and therefore does not provide equal reimbursement. Cowen financial analyst Charles Rhyee estimates $135 billion in Medicare’s annual spending could be done more cost-effectively via telehealth, according to Reuters.
2. In recent years, private insurers — which cover healthcare costs for almost 70 percent of U.S. adults under age 64 — have begun to incorporate telehealth reimbursement, and even encourage its members to receive services via remote technology. Mr. Rhyee estimates the average telehealth visit costs roughly $50, compared to $150 for an urgent care visit or $1,500 for an emergency room visit.
3. American Well CEO Roy Schoenberg, MD, told Reuters revenue in the telehealth industry might grow 10-fold if restrictions related to reimbursement and state lines were lifted. “There is a big black line between the availability of telehealth services to Americans under the age of 65 and Americans that are above the age of 65,” he said. “This [legislation] would be an earthquake.”
4. However, while telehealth visits are cost-effective, some experts speculate remote care will supplement — not replace — in-person consultations, leading to higher healthcare costs overall. “The healthcare system is still being educated in terms of the value of telehealth and where it’s best suited,” Matthew Gillmor, an analyst with brokerage firm Baird, told Reuters.
5. Telehealth-focused legislation is still making its way through Congress. However, whether legislators agree to pass the bills or not may depend on a report from the Medicare Payment Advisory Commission, which is slated for release in March.
More articles on telehealth:
UPMC Susquehanna rolls out inpatient ‘TeleEndocrine’ program to regional hospitals
Jefferson Health, Mission Health partner with telehealth vendor to develop 10 remote care models
Stanford, U of Florida researchers partner to improve Type 1 diabetes care with telehealth
