Healthcare News & Insights

Industry pushing for Medicare to cover telemedicine services

ThinkstockPhotos-488668115If there’s ever been a group of patients who could benefit from having telemedicine added to their care after they’re discharged from the hospital, it would be senior citizens. Physical limitations, as well as transportation issues can keep them from their follow-up appointments which can lead to readmissions. 

So why do fewer than 1% of Medicare patients use telemedicine? It’s not like it’s new technology.

One reason: The traditional Medicare program limits telemedicine payments to rural areas, and even then the patient has to be at a clinic, which pretty much defeats the convenience of telemedicine.

It’s been restricted because Congress is afraid telemedicine services might increase Medicare expenses. However, in 2012, Medicare paid $5 million for telemedicine compared to the program’s total spending of about $455 billion, according to a study in Telemedicine.

Time to expand

The telemedicine industry disagrees with Congress. It believes providing greater access to online care would cut down on doctor visits and unnecessary emergency care. It would also cut down on readmissions because people with physical and transportation issues would have access to follow-up care.

Kaiser Health News recently reported that even major organizations, like American Medical Association (AMA) and the American Hospital Association (AHA), believe it’s time for Congress to step up and expand the use of telemedicine in Medicare.

After all, non-senior citizens are currently taking advantage of telemedicine. In fact, Aetna and UnitedHealthcare offer telemedicine services to their members under 65 and there’s no restriction on where they live. And it’s estimated that 37% of large employers plan to offer telemedicine benefits this year, according to a 2014 survey by Towers Watson, an employee benefits firm.

The American Telemedicine Association, a trade group, estimates that about 800,000 online medical consultations will take place in 2015.

Currently, only two Medicare Advantage plans (Anthem and University of Pittsburgh Medical Center health plan) offer telemedicine services, and as previously stated, it’s with restrictions. Funny thing is, Medicare Advantage plans have the option of offering telemedicine services without the restrictions because they’re paid a fixed price by the government to care for seniors. Therefore, it’s the plan revenue that pays for the services not Medicare directly.

Cut down on costs

The restrictions Medicare puts on telemedicine services act as a deterrent, but hopefully that will be changing soon as Medicare accountable care organizations (ACOs) have started using the services, and more and more organizations are pushing for coverage for seniors.

Even the AARP is taking a stand on telemedicine services wanting Congress to allow them for all Medicare beneficiaries to be used in conjunction with seeing their primary care physician.

By keeping senior more connected to their doctors and more involved with their own care, they’re more likely to be compliant with discharge instructions after hospitalization. This in turn will cut down on readmissions because healthcare providers will be able to catch symptoms before they become serious and require an emergency room (ER) visit or hospitalization.

“We see the potential for it … to improve quality and lower costs, ” said Robert Wergin, president of the American Academy of Family Physicians and a family doctor in Milford, NE, in the Kaiser report.

Anthem, which currently has 350,000 Medicare Advantage members in 12 states, also see telemedicine as a way to improve care and cut costs. But that’s not the only reason it provides these services at no extra charge.”It’s also about the consumer experience and giving consumers convenience to be able to be face to face with a doctor in less than 10 minutes, 265 days a year, said John Jesser, an Anthem VP

As for risk, experts say it’s no riskier for senior to have telemedicine services than anyone else.

Yes, senior often have more complicated health issues, but doctors know what issues they can treat online and what they can’t. If they feel it’s something more serious, they’ll advise the patient to seek in-person treatment or ER treatment.



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