Reimbursement remains a major barrier to telehealth

Though the landscape for telehealth continues to evolve, uncertainty over provider payment and unever reimbursement remains a barrier.

Telehealth is making advances in other countries, but there's still much to work out in the United States, according to a blog post from law firm EpsteinBeckerGreen.

Medicare regulations remain restrictive, covering fewer than 20 telehealth services and about 30 codes. It defines telehealth as real-time communication through audio or video link. And the patient must live in or use a facility deemed part of a rural Health Professional Shortage Area. Writer Rene Quashie says it will take an act of Congress to expand Medicare payments for telehealth, something he considers unlikely since federal regulators aren't convinced of the benefits of telehealth for many conditions and they fear expanding the program would raise costs.

With the looming "fiscal cliff" posing the potential for cuts in Medicare reimbursement, the possibility of expanding telehealth remains even more unlikely.

About 40 states provide some telehealth reimbursement under Medicaid and state coverage tends to be more generous than Medicare. Private insurers' coverage varies as well. About a third of states have enacted telehealth parity statutes requiring equal reimbursement as for in-person services.

Quashie sees other opportunities for the growth of telehealth in other federal programs, including that of the U.S. Department of Veterans Affairs, which has been embracing telehealth in a big way. In September it announced a collaboration with the U.S. Department of Health & Human Services to award $983,100 in grants to improve telehealth services for veterans in Virginia, Montana and Alaska, for example.

Data collection and analysis should provide greater evidence of telehealth's benefits and its role in preventing readmissions, as required under Meaningful Use.

More success stories are cropping up about telehealth's role in reducing readmissions, such as the Central Indiana Beacon Community's pilot program, which uses remote video conferencing between nurses and hospital patients discharged with diagnoses of congestive heart failure, chronic obstructive pulmonary disease, or both.

Separately, a telehealth and care management program was found to significantly reduce mortality from all causes among high-risk Medicare beneficiaries with heart failure in Washington and Oregon, according to a presentation recently at the American Heart Association's Scientific Sessions.

Lead author Robert L Page II of the University of Colorado School of Pharmacy linked the success to a higher level of patient engagement in monitoring their health.

To learn more:
- read the blog post
- here's the presentation abstract