Telemedicine is revolutionizing the healthcare industry and is expected to grow from a $21.56 billion market in 2017 to a $93.45 billion market in 2026. This growth is highly attributable to the accessibility and convenience of telecommunication devices and the inevitability of government initiatives for reimbursement.
A study done by Truven Health Analytics found that nearly 71% of emergency department visits could have been safely treated in an urgent care clinic or primary care setting. With significant time and cost saving implications, telemedicine is set to become the answer for many of the grievances that hospitals and medical practices face on a daily basis. So what exactly is telemedicine? It is a way for healthcare providers from one location to connect and diagnose patients that reside in another location. There are three primary forms of telemedicine: store‐and‐forward, remote patient monitoring and real‐time telemedicine.
Store‐and‐forward is a method in which healthcare providers transfer patient data such as lab reports, digital images, videos of the patient and any other relevant information, to a specialist at another location. This communication between the specialist and the provider will then allow the provider to obtain a better understanding of the patient’s condition and make an accurate diagnosis the first time. It will also keep the patient from having to store paper‐based patient information only to lose or forget to bring their lab results to their next visit.
Second, remote patient monitoring (RPM) is designed for high risk patients that require close monitoring. The patient is typically prescribed a medical device that tracks their condition on an ongoing basis. The device can generate an alert if specific thresholds are met. These alerts are then reviewed by the physician, who determines if the patient needs to be scheduled for a visit. Remote patient monitoring is widely known in cardiology, diabetes and respiratory practices, and is now moving to ophthalmology and other healthcare areas.
Lastly, real-time telemedicine allows providers to interact with patients via real-time videoconferencing. During the consultation, the provider can complete the diagnosis and electronically prescribe a treatment. Real-time medicine is most commonly used for basic visual examinations, psychiatric evaluations and even ophthalmic tests.
The three different forms of telemedicine outlined above encompass a wide array of benefits such as reducing unnecessary ER visits, allowing doctors to see more patients in less time, improving the quality of care, reducing readmission rates and increasing the patient base. These services seem to have vast amount of benefits, but, there have also been concerns, one being reimbursement. The lack of understanding of the reimbursement policies that the three major payers, Medicare, Medicaid and commercial payers offer has prevented many establishments from implementing an effective telemedicine practice. Fortunately, restrictions on reimbursement policies are set to become more lax. One major change being with the Centers for Medicare and Medicaid Services final rule in 2019. This rule will expand telehealth access and reimbursement for patients in Medicare Advantage plans and doctors.
Telemedicine was initially seen as a way of connecting with patients in rural areas that may have limited access to adequate facilities. Currently, geographic restrictions under Medicare state that the patient must reside in a defined rural area. Set to take effect in 2020, CMS’s new ruling will eliminate geographical restrictions on telemedicine services in Medicare Advantage plans. This will allow those in urban areas to have the access to receive more benefits at lower costs and better quality. Along with this ruling also comes an expansion on telehealth reimbursement. Currently Medicare limits the use of telehealth by only allowing certain technology, patient settings, geographic locations and provider types which may be limiting the coding for new kinds of services that utilize communication technology.
With this new ruling, CMS has finalized reimbursement for virtual check-ins (HCPCS code G2012), remote evaluation of pre-recorded patient information (HCPCS code G2010) and inter-professional internet consultation (CPT codes 99452, 99451, 99446, 99447, 99448, and 99449), which CMS believes fall outside the scope of Medicare telehealth services. Hospitals and private practices should consider changing their current workflows, aligning with new telemedicine reimbursement codes and healthcare regulations to optimize their practice infrastructure.
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