May 06, 2019 by Ken Terry for Medical Economics

New rule provides telemedicine opportunity

The federal government recently finalized a rule that will allow Medicare Advantage plans to offer telemedicine as a core benefit. As a result, practices of all sizes will have a greater incentive to adopt virtual visits, observers say.

Traditional fee-for-service Medicare provides very limited coverage of telemedicine. For the most part, virtual care is covered only in rural areas, and virtual consultations must be initiated in healthcare facilities.

Providers can’t bill for virtual visits with patients from their homes, with one exception: CMS last fall ruled that physicians can bill traditional Medicare for brief “virtual check-ins,” in which they determine whether a patient should come into the office. Remote evaluation of video recordings and images is also covered. 

The new rule doesn’t expand telemedicine coverage under fee-for-service Medicare. However, it gives Medicare Advantage plans carte blanche to cover any form of telemedicine, wherever it is provided or initiated. Since more than a third of Medicare patients belong to these plans, this could mean a significant change for many physicians.

Some Medicare Advantage plans already cover virtual care as a supplemental benefit for which plan members must pay extra. Now that telemedicine is a core benefit, however, “providers would be more likely to invest in the infrastructure to make this available,” says Jerry Penso, MD, MBA, president and CEO of the American Medical Group Association (AMGA).

Steven Waldren, MD, vice president and chief medical informatics officer of the American Academy of Family Physicians (AAFP), says that when Medicare Advantage plans begin to cover virtual visits with patients’ own physicians, “I think it would convince more doctors to add telemedicine to their practices.”

Modern telemedicine

The telemedicine used today represents the confluence of two forms of the technology: secure online messaging, which has been around since the early 2000s, and virtual visits based on audio-video conferencing.

Until around 2015, video visits were usually conducted between patients and doctors who worked for outside services such as American Well, Doctors on Demand, and Teladoc. But there are inherent limits to this approach, because the outside doctors don’t know the patients who consult them, and they rarely coordinate care with the patients’ regular physicians.

“The critical piece is to make sure the care is coordinated,” Penso notes.

Today, however, the telemedicine medical practices use is likely to connect patients directly to their own physician or his or her colleagues, rather than an outside doctor hired by a service. Secure texting or online messaging is often the first step. Then the patient completes an online form, providing information that may be sufficient for a doctor to diagnose and treat his or her complaint. If the doctor and the patient believe a video visit would help, that might be the next step, or the patient might be asked to come into the office.

Chronic care follow-ups

Telemedicine is most often used to diagnose and treat minor acute problems like influenza, low back pain, conjunctivitis, and urinary tract infections. Some practices are also using telemedicine for routine follow-ups on chronic conditions.

“Virtual health has been great for my diabetic patients,” says Donnie Aga, MD, medical director of healthcare innovation for Kelsey Seybold, a large multispecialty group in Houston. “I know them really well, and they can go to the lab at any time; fasting is not an issue. For routine follow-ups on diabetes, it’s very well done.”

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