The Role of Telehealth in an Evolving Health Care Environment Workshop Summary (2012) / Chapter Skim
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5 Telehealth and Payment
5 Telehealth and Payment
Pages 31-42
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From page 31... ...
About 7 percent of rural Medicare beneficiaries travel an hour or more to receive care. Telehealth could improve access for these beneficiaries.
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Psychologists, psychiatrists, and clinical social workers accounted for 49 percent of the health care professionals who provided 10 or more telehealth services in Medicare. Physician assistants, nurse practitioners, and clinical nurse specialists accounted for 19 percent of the practitioners, and family medicine and internal medicine physicians accounted for 7 percent.
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An interesting research question would be to look at the trade-offs between the physician's time and the patient's time. For example, if telehealth technologies add time to the physician's work time, either through technical difficulties or administrative requirements, physicians may resist adoption of the technology.
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From page 34... ...
Medicaid covers live, interactive telehealth in 45 states and S&F services in 16 states. Fifteen states have laws that mandate private payers cover telehealth, but many private payers are covering these services even without mandates.
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Also, health care professionals lack training and mentoring in telehealth. Overall, Edison said, many things can support the adoption of telehealth, such as provider payment reform, integrated care, meaningful use, and a mature electronic health information exchange environment.
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The PCMH model creates incentives for providers to ensure their patients are not readmitted to hospitals or having unnecessary visits to the ED. Engagement of patients in disease management strategies is challenging, but providers might be able to work with their patients over the Internet to discuss health promotion and to reconcile medications.
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. Myriad devices offer remote monitoring for things like vital signs, medication adherence, and detection movements (e.g., falls)
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Nesbitt added that payers may be moving ahead because of consumer demand, but that even when providers are paid to use telehealth, there are still barriers to finding providers willing to do so. Finally, Nesbitt stated that all the new and emerging payment models give hope for the great opportunities of telehealth.
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From page 39... ...
Another participant called for fundamental change in how we pay for health care, noting that the current system pays more for procedures and hospital-based care, and does not pay well for preventive care. Magno responded that existing Medicare policy is governed by constraints within statute, and that CMMI hopes that innovations can help shape changes in policy.
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She stated that as the electronic health information exchange environment evolves, more consideration will be needed for how that should impact payment. State-Based Payment Reform One participant asked what could be done at the state level (e.g., policy, legislation)
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From page 41... ...
The Increased Costs of Telehealth Stensland questioned whether telehealth could lead to increased costs, such as the replacement of a request by phone for a prescription refill with a billable consultation. Both Stensland and Oza suggested that telehealth might be better paid for as part of a per member per month payment, but Oza noted that physicians are skeptical about whether telehealth will increase or decrease their incomes.
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