Medicare telemedicine reimbursements totaled $13.9 million in calendar year 2014the highest level to date. But, critics argue that the figure is nowhere near where it should be.
The 2014 payments included $12,482,270 in provider fees at the distant site (the location of the telemedicine provider) and $1,452,160 for originating site fees (the location of the patient).
The Centers for Medicare and Medicaid Services provided the data to the Robert J. Waters Center for Telehealth and e-Health Law (CTeL), a legal and regulatory organization that focuses on issues impacting the advancement of telehealth.
This data only reflects services paid under the Medicare Telehealth benefit, which only includes services otherwise furnished in-person and would not include professional interpretations of diagnostic tests, for example, that are not subject to Medicare telehealth rules, cautions CTeL. These services are often referred to as Telehealth, but are not included in this data.
Since 2001, CMS Medicare reimbursement for distant site services amounts to $51 million and $6.5 million for originating site fees, totaling $57.6 million. Although CTeL reports that CMS reimbursement for distant and originating site telemedicine services has steadily increased since 2008, industry groups argue that it is a paltry amount compared to overall Medicare spending.
The fact that in 2014 Medicare reimbursed $14 million for telehealth services out of a total of approximately $615 billionmerely 0.0023 percent of total spendingreflects the low priority placed on telehealth by Congress, said Joel White, executive director of Health IT Now, a coalition of patient groups, provider organizations, employers and payers that supports HIT incentives. In the private sector, at the VA, and in the DOD, new technologies are being integrated directly into the acute medical benefit, but Medicares law is stuck in the 20th century.
Health IT Now has called on Congress to remove such telehealth restrictions. Toward that end, the organization supports the House Energy and Commerce Committees recently released discussion draft for its so-called 21st Century Cures initiative.
We encourage Congress, through 21st Century Cures and other initiatives, to work to remove current barriers to telehealth services under Medicare, states White. One promising area would be to vary reimbursement levels for telehealth services. Health IT Now believes that the use of technology in healthcare can lower costs, and this should be taken into consideration when developing reimbursement rates for services provided via telehealth.
However, White hastened to add that Health IT Now does not believe that telehealth visits should be automatically reimbursed at the same amount as in-person visits. Unfortunately, some cling to the notion we must have parity in reimbursement, even though studies show the costs of providing services are less, he said. That makes no sense. If it costs less, we should pay less.
In addition, according to White, telehealth legislation to remove barriers under Medicare would not be complete without addressing interstate medical licensure. In todays mobile society, people are traveling more and using technology we never imagined just a short time ago, he concludes. In order to provide quality care, promote care coordination, and reduce redundancy in the healthcare system, Health IT Now believes that Medicare doctors should be able to treat Medicare patients across state lines without having to obtain multiple state licenses.
The House Energy and Commerce Committees Health Subcommittee is scheduled to hold a markup session today on the 21st Century Cures Act. On Wednesday, the committee released an updated draft of the bill to be considered by the subcommittee.
It is the sense of Congress that states should collaborate, through the use of state medical board compacts or other mechanisms, to create common licensure requirements for providing telehealth services in order to facilitate multi-state practices and allow for healthcare providers to provide such services across state lines, according to the latest draft bill.
The proposed legislation goes on to state:
Eligible originating sites should be expanded beyond those originating sites described in section 1834(m)(4)(C) of the Social Security Act; and any expansion of telehealth services under the Medicare program should recognize that telemedicine is the delivery of safe, effective, quality healthcare services, by a healthcare provider, using technology as the mode of care delivery; meet or exceed the conditions of coverage and payment with respect to the Medicare program under title XVIII unless specifically address in subsequent statute, of such Act if the service were furnished in person, including standards of care; and involve clinically appropriate means to furnish such services.
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