Coverage, reimbursement remain barriers to telehealth use, health industry leaders testify

Coverage and reimbursement of telehealth, especially for Medicaid and Medicare, was the topic of choice during a roundtable discussion held by the U.S. Senate Special Commission on Aging on Tuesday.

During the discussion, government officials and healthcare leaders spoke about the issues facing telemedicine when it comes to the laws and regulations surrounding the technology.

Jack Resneck, M.D., a member of the American Medical Association's Board of Trustees, said the main roadblocks for telemedicine use have been geographic restrictions and dual eligibility for patients who are on Medicare and Medicaid yet fall under Medicare restrictions.

"When I talk to physicians in the field who are dealing with the challenges of telehealth on a daily basis, really the primary challenge that I hear from most is coverage and reimbursement," he said.

Neal Neuberger, executive director for the Institute for e-Health Policy, echoed Resneck's statements.

"Not a whole heck of a lot has gone forward on the reimbursement side," he said regarding laws and policies. "It's time for both sides of the aisle, both Houses ... to come together, and come out with a series of doable recommendations that are scorable."

Marc Hartstein, with the Centers for Medicaid & Medicare Services, said while he couldn't say what should or shouldn't be done in regards to the laws that restrict telehealth--which he did note were about 14 to 15 years old--CMS is willing to work with Congress to address any issues there are.

"If Congress feels it's time to reexamine those laws, we certainly would be willing to work with the Hill to assist with … reviews or changes," Hartstein said.

CMS has recommended that telemedicine coverage for Medicare beneficiaries be expanded, most recently in its proposed update to the Medicare Physician Fee Schedule for 2015, which was praised by industry stakeholders, including the American Telemedicine Association and the American Hospital Association.

Alice Borrelli, director of global healthcare policy at Intel Corporation, pointed to ways that telehealth is helping people address chronic disease management, asking Hartstein what evidence CMS needs to show that telehealth is a valuable tool.

Hartstein replied that for coverage of remote monitoring, Medicare evaluates if there is a provision in the law that would allow them to pay for a specific service. If there is, the next step is to find out if the service is necessary for treatment of illness or injury.

"There is some of this technology that we're currently paying for. There could be other technology that we have the potential to pay for if there were actually a way to bill for it," he said, mentioning the need for codes to describe the services.

Ralph Sacco, chairman of the department of neurology at the University of Miami Miller School of Medicine, stressed the need for telehealth in areas that are not just underserved, but also in urban areas, especially when it comes to telestroke care.

"We would urge Medicare to consider expanding the coverage beyond rural … and when we use the term 'health professional shortage area,' a large part of the United States is probably a 'health professional shortage area.' We need to broaden that definition," he said.

A recent pair of state policy reports on telemedicine from the American Telemedicine Association show gaps in coverage, reimbursement, practice standards and licensure across the U.S.

To learn more:
- listen to the roundtable discussion

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