Tucked in to the federal budget law Congress passed in February was a provision that significantly expands using telemedicine – long a hyped health care reform, and today poised to visit mainstream within five to Ten years.
“There's much broader recognition from the benefits,” said Mei Wa Kwong, executive director from the Center for Connected Health Policy, a research group that promotes telemedicine in Sacramento, Calif. “The law is the latest to create telemedicine more accessible. But we still have a ways to go before most individuals are conscious of the choice.”
The new law allows Medicare to pay for telemedicine services for those who have were built with a stroke and those who get kidney dialysis, either both at home and at a dialysis facility. It also permits Medicare Advantage Plans – private plans that enroll a third of Medicare beneficiaries – to provide telemedicine as a covered benefit.
Separately, as of Jan. 1, Medicare began allowing doctors to bill the federal government for monitoring certain patients remotely using telemedicine tools – for instance, tracking heartbeat and rhythm, blood pressure and blood sugar levels.
Telemedicine, also referred to as telehealth, uses computers – as well as their display monitors, software and convenience of data analysis – to provide virtual health services.
In the easiest-to-understand example, a patient is in one location and it has an e-visit with the doctor in another location. They're connected via a secure video link. Proponents say that modern-day monitoring is on the horizon which virtual encounters will become more commonplace.
As acceptance and adoption of telemedicine expands, the same is true coverage. All private health plans, Medicare, state Medicaid programs and also the Department of Veterans Affairs now cover some e-visits – albeit with restrictions. More health centers and hospitals are launching virtual health centers. And websites offering virtual “doctor-on-demand” services are proliferating.
Concerns exist, however. Doctors worry that they're going to receive money less if insurance reimbursement is lower for e-visits than in-person appointments, or that e-visits could undermine the doctor-patient relationship by reduction of valuable face time. They explain that for some ailments, like strep throat, it’s best if doctors or other health providers see the patient.
Health economists, meanwhile, are concerned that e-visits could add to costs instead of constrain them – if, for instance, doctors and patients abuse e-visits by scheduling them unnecessarily since they're quick and easy. Also, insurers might be motivated to push doctors to complete more e-visits instead of in-person appointments with cut costs. And for some people, access to proper equipment or access to the internet can be challenging.
“The possibility of abuse can there be,” says Dr. Robert Berenson, a Medicare expert at the Urban Institute. “We will need to prevent gaming and misuse from the system. But, generally, helping people avoid unnecessary doctor's office and hospital visits is a great thing, if we still do it.”
Here's a briefing on telemedicine basics:
Q: Are e-visits offered by most hospitals and doctors?
Not yet. But access is increasing. Ask your physician, clinic or hospital.
In some cities, medical centers are setting up telehealth “hubs” to deal with patients. For instance, Penn Medicine in Philadelphia launched its Connected Care center in February with 50 full-time employees, 24/7 use of care along with a program to treat chronically ill patients in your own home. Some of the center's e-visit services are open only to Penn Medicine employees, but other services are available to anyone, with a focus on residents of Pennsylvania, New Jersey, Delaware and Maryland, said Bill Hanson, vice president and chief medical information officer at Penn Medicine.
Similarly, Mercy Virtual in Chesterfield, Mo., a St. Louis suburb, serves patients through the Midwest, and those treated at Mercy Health's network of 44 hospitals in five states. Launched in 2021, Mercy Virtual provided choose to 750,000 individuals 2021 with a team of 700 doctors, nurses and support staff.
Other medical centers with virtual health programs include Avera Health based in South dakota; Cleveland Clinic in Ohio; Dignity Health in Bay area; Intermountain Healthcare in Utah; and Kaiser Permanente, a managed-care health system in California and elsewhere.
Kaiser Permanente reported this past year that 21 percent of their 110 million patient interactions in 2021 were e-visits. Officials there predict that by 2021 e-visits will exceed in-person visits. (Kaiser Permanente isn't associated with Kaiser Health News, which is an editorially independent program from the Kaiser Family Foundation.)
Q: What restrictions do health plans, Medicare and Medicaid placed on e-visits?
Health plan coverage varies, but many private insurers cover e-visits, and 34 states and also the District of Columbia require they do. Several states still require that a patient relationship be established with an in-person visit prior to the provider can bill to have an e-visit. Seek advice from your insurer about its policies.
Medicare's coverage of e-visits is much more restrictive. First, e-visits will need to take the area of an in-person visit. Second, with exceptions allowed under February's budget law, Medicare largely restricts e-visits to those that occur in rural areas which have a shortage of doctors and/or hospitals. And third, most e-visits can't occur when the patient is at home. They may be done from a number of areas, like a rural health clinic, a dialysis center or skilled nursing facility. An invoice in Congress would loosen that restriction.
In contrast, almost all state health programs cover e-visits in your home. But restrictions still apply. For example, only 22 states cover remote patient monitoring for Medicaid enrollees.
The Telehealth Resource Centers, a federally funded organization promoting telemedicine and providing consumer information, has detailed explanations of e-visit restrictions and limitations.
Q: Do I need special computer equipment?
No. E-visits and other types of telemedicine are done over commonly available computers, laptops, tablets and smartphones – and are typically encrypted to safeguard privacy. Specialized devices are usually required for remote monitoring, for example blood pressure or heartbeat. One vexing barrier: broadband availability in rural areas. Also, countless low-income and older Americans still lack Wi-Fi within their homes.
Q: What services can I get through telemedicine?
Most e-visits are for primary care or follow-up services, such as assessing symptoms or checking on people who have were built with a surgical procedure. But an increasing number – no one keeps national statistics – cater to people with chronic conditions who're being monitored at home, said Kwong.
Dermatology e-visits are becoming especially common. You can send a close-up photo of a skin rash, mole or any other problem to have an immediate assessment. Psychotherapy by e-visit can also be expanding.
Sometimes an e-visit may provide an initial medical assessment for an injury, wound or illness that is clearly not life-threatening. Some cities are testing ambulance services that use telemedicine to triage whether individuals need a visit to the hospital.
Q: Am i going to cut costs basically do an e-visit instead of entering the doctor's office?
E-visits are generally less expensive than a trip to the doctor, however, you might not see the difference if your insurance covers both with simply a small copay or no copay. If you have a large deductible, however, an e-visit may mean you pay less out-of-pocket for your encounter.
Some states require insurers to create equal reimbursements for in-office and telemedicine consultations on simple matters.
Q: Are there downsides or risks with telemedicine and e-visits?
There's no evidence so far that the risk of being diagnosed wrongly or treated inappropriately is any greater with an e-visit when compared with an in-person visit.