With the spreading net of broadband internet coverage reaching into the most rural areas and accountable care rising in popularity, the time seems right for telemedicine to take center stage in the debate about how to extend cost-saving preventative medicine to patients over the airwaves. Telehealth is nothing new, but it’s becoming increasingly popular with Medicare and with private insurers as a way to conduct mental health screenings, basic pre-natal care, and chronic disease management without the time and expense of a visit to the doctor’s office. However, state laws surrounding remote consults are convoluted at best, and many states are still debating whether or not Skype conversations can be reimbursed by private payers.
Medicare has led the way in telehealth coverage for years, and since private payers often look to the government program as an example of what they should pay, one would think that commercial health plans would be jumping on the bandwagon. Many are doing so, offering telehealth services through partnerships with companies like RelayHealth and MDLive, as a way to slash expenses and offer convenience to patients. “We believe telemedicine can play a critical role in improving health and managing chronic disease, while increasing member satisfaction,” said Ethan Slavin, a spokesman for Aetna, to Healthcare Finance News. “Telemedicine can also significantly reduce costs by reducing non-medically necessary ER visits and readmissions as members use virtual options for after-hours care and provider instruction.”
But when traditional healthcare providers want to connect with far-flung patients themselves and then be reimbursed after the fact, the situation becomes a little dicier. Many states have legislation mandating Medicare and Medicaid coverage for remote services, primarily interactive video chats, but private coverage laws are spotty at best. The majority of Midwestern states, including Nebraska, the Dakotas, and Wyoming, places where telemedicine is popular among rural residents, have no parity laws about private insurance coverage.
The American Telemedicine Association (ATA) tracks pending and approved legislation governing telemedicine reimbursements, and has found that state attitudes vary widely. Colorado, for example, has legislation approving telehealth as an allowable method of delivering occupational therapy services, while Vermont has only authorized a pilot program to study the delivery of care outside a traditional healthcare setting. Massachusetts has proposed comprehensive mandates to include telehealth in Medicaid, state insurance programs, and private payer plans, but Alaska’s attempt to grant licenses to out-of-state physicians for telemedicine died in committee.
Telemedicine is still often seen as a bonus benefit for farming communities and not a mainstream way to provide quality patient care. While many more states, including Connecticut, Florida, Illinois, Kansas, and Missouri currently have legislation in the works to expand their telehealth coverage, attitudes towards video consults and internet chats are only slowly changing, despite the private payer enthusiasm. “We see that telemedicine may complement the patient-physician relationship by making it easier for physicians to deliver care effectively and efficiently, facilitate communication with patients, and help improve patient safety,” Slavin says.
Whether state laws catch up to the private sector’s push for telehealth coverage as the continuum of care and preventative medicine transform healthcare delivery still remains to be seen. For now, physicians who wish to offer telehealth consults will need to pay close attention to their state’s current guidelines as they navigate an ever-changing maze of legislation.