Cheers and jeers for Medicare 'e-visits'

Last week, as you may recall, FierceHealthFinance reported that Medicare had proposed rules allowing hospitals to bill for e-visits. Generally speaking, my reaction to this announcement was to applaud the move, as I keep reading studies that suggest telemedicine can be both clinically and financially effective. At least one reader agreed with me:

We hope you are right about the possibility of medicare support for e-visits. We're mapping a Maui connected care system to help people age in place. A key component of the system we envision will be to empower family caregivers and older adults with PHRs, digitally-assisted disease management programs, and virtual house calls. To paraphrase Joe Coughlin at MIT AgeLab: The need and technologies are here. Now we need the will and the imagination to build connected care systems that decrease healthcare costs and improve quality of care and the quality of life of our aging baby boomers!

Another reader, however, brought up some points I hadn't considered regarding the risks that that could be created by implementing such a program too quickly:

I find the very proposition of Medicare taking on virtual health care coverage and billing without a sound IT plan and a sound monitoring and checks/balances mechanism in place to be, potentially, a vehicle for massive fraud and a further dilution of the already out of control Medicare program. I am not in the least against the use of legitimate telemedicine to supplement in-person medical care; however, Medicare has not been shown to be mechanically capable of handling current billing programs, much less overseeing a wide-spread addition of an electronic program, which could be very, very costly and potentially fraught with problems.

Any viable IT integration requires a strong plan, mechanism for implementation that works at many levels, and a means of addressing issues. A national program and huge economically entrenched offering requires not only good guidelines and effective tactics, but also oversight, an area that Medicare has long lacked. Until we can get a grasp on Medicare and audit, what is being billed and how Medicare is handling billing codes, don't you think it's best we not add an entire other level?

In reality, I don't think these two readers disagree about the value--it's just that that our critic isn't convinced that Medicare can handle the back end. And in all honesty, I believe he's right to be concerned about the potential for fraud.

However, given that telemedicine is likely to become an accepted way of delivering care sometime soon, it seems to me that Medicare administrators are wise to roll out a program allowing them to "get their feet wet." After all, the new e-visit program covers only physicians' consults with patients they've already seen in the hospital, a fairly limited subset of Medicare patients. Starting there might just give CMS the opportunity to smooth out potential wrinkles in the program.

I admit that CMS could indeed end up dropping the ball and allowing fraud to flourish as telemedicine options emerge. But with all due respect to our skeptic, I still maintain that if the agency is going to do anything to respond to trends, this is a good place to go. - Anne


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