Doctors Give Medicare's Proposal To Pay For Telemedicine Poor Prognosis


The Trump administration wants Medicare for the first time to embrace telemedicine across the nation by paying doctors $14 for any five-minute “check-in” telephone call using their patients.

But many physicians say the proposed reimbursement will cover something they already do free of charge. And the Medicare reimbursement – intended to motivate doctors to talk with patients away from office – could have a chilling effect on patients because they would be required to pay a 20 percent cost-sharing charge.

Medicare said the phone call could be accustomed to help patients determine whether they have to come in to have an appointment. But doctors and consultants said the virtual sessions could cover an extensive array of services, including monitoring patients starting a new medicine or those trying to manage chronic illnesses, such as diabetes. The Medicare Payment Advisory Commission, which provides guidance to Congress, panned the proposal recently, saying it could lead to excess spending without benefiting patients.

“Direct-to-consumer telehealth services – seem to expand access, but in a potentially significant cost and without evidence of improved quality,” the commission's chairman, Dr. Francis Crosson, said in a letter towards the Centers for Medicare & Medicaid Services (CMS). “Due for their greater convenience, useful at risk of misuse by patients or provider.”

Congress has shied from expanding the use of telemedicine in Medicare – even while it is commonplace among private insurers – due to concerns about higher spending. Budget hawks worry that instead of replace comparatively expensive in-person visits, extra telemedicine billings would add to them.

Lack of coverage – except in rare circumstances – means fewer than 1 % of the 50 million Medicare beneficiaries use telemedicine services every year.

Federal law forbids Medicare from paying for telemedicine services that replace in-person visits to the doctor, except in certain rural areas. This is exactly why CMS called the new benefit a check-in using “virtual” or “communications technology,” said Jacob Harper, which specializes in health problems in the law practice Morgan, Lewis & Bockius.

In addition to the check-in call, CMS has proposed starting to pay physicians to review photos that patients text or email to them to judge skin and eye problems, as well as and other conditions. It also has proposed paying physicians an unspecified fee for consulting electronically or by telephone along with other doctors.

“Innovative technology that enables remote services can expand use of care and make more opportunities for patients to access personalized care management in addition to connect with their physicians quickly,” said CMS Administrator Seema Verma when announcing the proposal.

CMS said it hopes to enact the alterations in 2021. Officials will announce their final rule after evaluating public comments on the plan.

Verma and other CMS officials say they feel the change would end up saving Medicare money by reduction of unnecessary office visits and catching health problems early, before they be costly to treat.

But in its detailed proposal, CMS acknowledges the telehealth service will increase Medicare costs. CMS said the telehealth can lead to “fewer than A million visits within the newbie but will eventually lead to more than 19 million visits each year, ultimately increasing payments under the [Medicare physician pay schedule] by about 0.2 percent,” or eventually about $180 million each year. Since the change must be budget-neutral, CMS is paying for this by decreasing another Medicare physician payments.

CMS doesn't expect rapid adoption from the telehealth service, partly because doctors could possibly get paid from $35 to $150 for an in-person visit. “Because of the low payment rate relative to that for an office visit, we're let's assume that usage of these services is going to be relatively low,” CMS said in the proposal.

The virtual check-in could be conducted by physicians or healthcare professionals or physician assistants using a doctor.

Only patients who've established relationships having a doctor could be eligible for the service. Doctors also would 't be allowed to bill for that check-in service if it stems from an in-person visit or is followed by an appointment with the doctor, according to the CMS proposal.

Dr. Michael Munger, a family physician in Overland Park, Kan., and president of the American Academy of Family Physicians, said many doctors routinely check on patients by phone. Still, he applauded the effort to improve physician pay.

“Anytime you can tie payment to what we're all already doing is nice,” he said.

Mercy, a large hospital system in St. Louis, has been offering telehealth services even without reimbursement because it helps patients access care and lowers costs in the long run, said Dr. J. Gavin Helton, president of clinical integration at Mercy Virtual.

“We already are on this path, and this will help to continue to grow our programs making them financially sustainable,” he explained.

Still, Helton said the “check-in” fee from Medicare will not be enough to motivate providers to start telehealth services.

He said the brand new reimbursement signals that Medicare really wants to purchase services to keep patients well as opposed to just treat them while they're sick.

Other physicians were more skeptical, particularly while Medicare has additionally proposed reducing some fees for in-person office visits.

In instructions to CMS, Dr. Amy Messier, a family medicine doctor in Wilmington, N.C., raised concerns concerning the effect this might have on patients' expenses.

“I worry about implementation of this from the patient perspective now that we're charging patients with this previously free service and they've to pay their area of the charge,” she said.

“Patients is going to be less likely to engage their physician outside the appointment and more prone to seek care face-to-face at more expense, when perhaps that visit could have been avoided having a telephone call which they won't make since it has a charge,” she said.

Dr. Todd Czartoski, chief executive of telehealth at Providence St. Joseph Health in Renton, Wash., predicts most doctors won't use the proposed telehealth service.

“It's still easier for any doctor to go area to area with patients arranged,” he explained. “It's one step in the right direction, however i don't believe it'll open the floodgates for virtual care.”