Healthcare payment policies advance at a much slower pace than technology does.
In Minnesota, Mayo Clinic’s Randy Schubring, the clinic’s public policy manager, tells the Star Tribune that federal insurance program Medicare advances especially slowly when it comes to payment technology, and that “Medicare reimbursement for telehealth is kind of stuck in the 1990s.” Telehealth, or telemedicine, is an umbrella term that refers to the provision of medical care over a distance. It incorporates everything from one doctor electronically forwarding digital x-rays to another for consultation to video conference visits between doctors and patients over secure networks that work like Skype.
What Medicare does with telemedicine is important, because Medicare often sets the trend for what happens in the private insurance market. This could change with the advent of telemedicine, however, because private insurers and Medicaid (which is administered by the states) are starting to move ahead with or without Medicare. But Medicare reimbursement for telemedicine is an important issue to Americans over 65, and in 2014 there were 46.2 million Americans in this age group, according to US Census data.
Legislation Concerning Telemedicine Reimbursement Is Slow
Medical leaders at facilities like Mayo believe that practically every day they demonstrate the effectiveness of telemedicine. Yet because Congress has not imposed any deadlines on Medicare as far as reimbursing telemedicine services, legislation involving Medicare telemedicine reimbursement has proceeded at a snail’s pace.
For example, proposed legislation ordering the Centers for Medicare and Medicaid Studies (CMS) to draft plans for telemedicine reimbursement for Medicare services is open ended. For one thing, the House hasn’t yet voted on the bill, and the Senate won’t take up any measures until later in 2015. Should the House bill eventually become law, it directs Medicare regulators to make a list of reimbursable telemedicine services one year after the bill is approved.
Federal Action Is Needed, Say Some Experts
Telemedicine is advancing at the state level, but that’s mostly a case of necessity being the mother of invention. Doctors are licensed at the state level, and private insurance companies have to make sure the doctors they reimburse are only delivering telemedicine services in states where they’re licensed to practice. While this piecemeal approach is moving forward, healthcare innovators at Mayo and elsewhere believe that federal policies are necessary to move telemedicine forward.
As long as the burden of meeting licensing restrictions rests on doctors themselves, telemedicine cannot expand as rapidly as it might otherwise. Federal policies could change licensing requirements and speed along reimbursement of telemedicine services, however. Right now, 27 states have laws that required insurance to cover telemedicine services, which is a great start, but it hasn’t done much to prompt Medicare into action on its own telemedicine reimbursement policies.
Mayo Clinic’s eICU
Mayo launched its electronic ICU (eICU) in 2013, a service which now has 95 beds in seven Mayo Clinic hospitals in three states. More facilities are joining in later this year. The technology is more than ready. In fact, Mayo has fielded inquiries about expanding eICU services from as far away as the Middle East. Practically speaking, however, expansion of the eICU will depend on what happens with Medicare and other US health insurance companies.
The eICU allows nurses to remotely read vital signs and see video images of patients who are eICU patients, but who are physically located at other facilities. By watching patient data and talking remotely to patients, eICU staff can alert staff at the remote facilities if a patient should require a procedure. The staff of the eICU also monitors feedback from both doctors and patients themselves about patient progress.
Mayo to Medicare: Telemedicine Isn’t Just for Rural Patients Anymore
A major point Mayo and other major facilities want to get across to Medicare is that telemedicine is not just for rural patients anymore. Medicare reimburses a small number of telemedicine services, but only as long as certain criteria are met. Patients must live in an officially designated Health Professional Shortage Area or in a county outside a metropolitan area. Furthermore, telemedicine treatment has to take place at a medical facility local to the patient, not at the patient’s home.
Limited reimbursement is a major obstacle to telemedicine expansion, in some cases making timely, high quality, appropriate healthcare for patients impossible. Mayo very much wants to provide telemedicine services, and doing so will require the cooperation of Medicare.
Both Congress and Medicare Will Have to Act
Medicare regulators draft rules rather than laws, and because of that, congressional empowerment may be required for Medicare to start addressing telemedicine concerns on a larger scale. But Congress isn’t moving forward fast enough, according to the American Telemedicine Association and other trade groups. Changing Medicare’s telemedicine reimbursement policies could take years, during which time private insurers could eclipse them in terms of expanding telemedicine and reimbursing telemedicine services.
Despite lack of cohesive policy about telemedicine reimbursement, the market is ready for expansion. Some market analysis experts are saying that healthcare delivered via secure video conference could be the prevailing virtual medicine technology by the year 2020. With “only” 19.7 million video telemedicine visits in 2014, telemedicine services are expected to account for nearly 160 million physician visits in 2020. Currently there are around 1.25 billion ambulatory care visits to doctors’ offices, emergency departments, and outpatient clinics, and telemedicine could eventually take care of one-third of these, saving all parties involved time and money.
Mayo Clinic Pushing Forward with Telemedicine in Minnesota
Though administrators at Mayo hope that things will change as far as Medicare reimbursement of telemedicine visits, they’re still pushing ahead with their use of telemedicine, because of the benefits it offers them and patients. The clinic is already monitoring some patients at home, ready to alert at-risk patients if a change in their condition requires that they see a physician in person or head to a local emergency department.
Doctors have the ability to, for example, track health indicators like heart rhythms remotely, and the problem isn’t getting the data, but rather knowing how to manage the avalanche of patient data that results from this type of telemedicine intervention. With data acquired through telemedicine monitoring, it’s really an “embarrassment of riches” situation.
Mayo is far from the only medical facility hoping that Medicare will update its rules to better accommodate telemedicine for patients over age 65. With incidents like stroke, telemedicine can allow local help from on-call vascular surgery specialists without the burden of transferring a patient to a major medical center. In these cases, telemedicine can save money, save time, and save lives.
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