Dr. Iltifat Husain’s physician take is at the end of this article
The Medicare Payment Advisory Commission (MedPAC), which advises the US Congress on payments to private insurers that participate in Medicare and payments to clinicians who care for Medicare beneficiaries, recently met to discuss telemedicine’s role in healthcare. The Commission’s comments, which suggested it may be unfamiliar with the intricacies of telemedicine according to Politico, may have been influenced by its staff, which said that “while telemedicine clearly could improve patient access and convenience, its impact on quality and cost were mixed.”
MedPAC staffer Amy Phillips, for instance, pointed out that “a 2011 study found improvements in mortality for patients with congestive heart failure using telemedicine, but research published the following year found the opposite,” according to the Politico coverage of the MedPAC meeting on Nov 6.
Apparently the Commission has its doubts about whether telemedicine would lower costs and improve quality of care, but it was nonetheless open to new data. During the brief discussion on telemedicine, Jack Hoadley of Georgetown University’s Health Policy Institute, asked: “Are there means to broaden the ability to use it that would look as scoreable — at least as neutral, not necessarily as savings?”
Politico’s reaction to the proceedings was less than encouraging: “Don’t expect formal recommendations to Congress in the near future.”
Although MedPAC is not ready to offer a glowing endorsement of telemedicine at this point in time, there are indications that Washington is taking a closer look at the field. In July, 4 members of the House of Representatives introduced the Medicare Telehealth Parity Act (HR 2948). The bill aims to improve coverage for telemedicine services for Medicare patients and eventually put it on par with in-person patient visits. If HR 2938 is enacted, it would provide Medicare coverage for telehealth services in rural, underserved, and metropolitan areas and expand telestroke services.
Dr. Iltifat Husain’s take:
MedPAC’s concerns about telemedicine being an effective solution are well founded. To date, there are still mixed literature results on this. But it underscores the concerns everyone has about Telemedicine as a whole, and an odd Catch 22. Until reimbursement for telemedicine meets in person visits, we won’t see innovation in this area and real change.
Right now, innovation has stalled because major players are waiting on the sidelines to see if legitimate reimbursement solutions will actually happen. Several telemedicine type services have been available already. Google had a HIPPA compliant video platform — Google Helpouts — until it was pulled recently. The biggest player right now is Teledoc — but these are platforms that don’t rely on an insurance reimbursement model.
With Medicare / Medicaid reimbursements overall declining, many physicians have stopped taking these patients. Telemedicine offers physicians the ability to see more patients with lower overhead. You could see a boom in access to care if there was some sort of reimbursement parity.
But for us to see legitimate public health change, from telemedicine visits and innovation in this arena, physicians need the reimbursement dollars to be there.
