Telemedicine is quickly gaining momentum for its potential to increase access to health care while offering significant cost savings. This trend towards supplementing and replacing traditional in-person consultations with remote care, especially in the critical care setting, raises many questions. Is this technology an effective proxy for face to face medical care? How will insurers incorporate these services into their coverage? With our country in its current budget crisis, these questions are quickly becoming more and more relevant.
The CMS has recently proposed increasing its coverage of telehealth services. While Medicare has covered telemedicine dating back to 1999, it has historically used a “comparability standard” in which physicians had to prove that their specific telehealth service was equivalent to in-person care. Now, the CMS may switch to covering telehealth that has “proven clinical benefit.” This would increase the range of services eligible to be covered, and in turn could increase access to providers, especially in rural and under-served areas.
An important caveat, however, is that the CMS specifically states that they will not cover telehealth in the context of critical care. They argue that there is not strong enough evidence that technology such as tele-ICUs and remote care for stroke patients have the same diagnostic/therapeutic outcomes as having physicians in the actual ICUs.
There are studies that show that critical care telemedicine can be effective. Our recent post discusses a study published in JAMA that showed remote monitoring by e-ICUs did in-fact reduce mortality. However, as we discussed in that post, there were important limitations to even this study, not to mention a background of conflicting data.
It is understandable that Medicare is treading carefully with new technology. With significant budget cuts looming in the wake of our country’s debt crisis, Medicare will doubtlessly look to mHealth, telemedicine, and other new treatment modalities to reduce costs, but must also make sure that these services have an established clinical efficacy before charging forward. Look for more studies evaluating telemedicine in various contexts – this technology will definitely have a significant impact on patients, payers, and providers alike in the near future.