WASHINGTON, D.C.—New telehealth gadgets and applications are popping up every day, but physicians are usually still left with the same old questions about them: Do they work? Will I get sued? And can I get paid?
The answers to those questions may be coming as soon as Thursday in the form of a new physician payment schedule, according to a panel by the Internet Innovation Alliance. And if it answers the outlying questions satisfactorily, panelists said 2018 could become the year when telemedicine moves into the mainstream.
"This has been an incredible year for digital medicine," said Sylvia Trujillo, senior Washington counsel at the American Medical Association, during the panel. "It will likely go down in the books as the turning point for digital transformations, in my opinion."
Trujillo pointed to pending changes in the physician fee schedule, more flexibility at the Department of Veterans Affairs to bring virtual care into patients' homes, and new laws lifting restrictions around Medicare reimbursement for telehealth.
Connected diagnostics tools—like a foot ulcer detector for diabetes patients—are becoming increasingly capable. The particular model Morgan Reed, president of ACT, the App Association, demonstrated at the panel is FDA-approved, takes only 20 seconds to gather diagnostics, has a battery life of three months and uses 2G connectivity to automatically upload the data to the patient's doctor. And it can detect foot ulcers in patients with diabetes five weeks before they become clinically obvious.
But solutions like this aren't frequently used because insurance programs, be they employer-sponsored or public, don't necessarily pay for them. The panelists all expressed hope that the Centers for Medicare & Medicaid Services (CMS) would soon clear things up in the new schedule.
CMS, which is in the process of authorizing the new physician payment schedule, sent a representative to the panel as well. Given the pending nature of the rule, Ryan Howe, Ph.D., CMS' senior technical adviser, couldn't provide many specifics, but he hinted that the rule would open up more digital health opportunities.
"I hope it's apparent the agency is really interested in making sure we're promoting innovation in medical care, in technology, in making sure that our regulations and restrictions aren't getting in the way of evolving medical practice," Howe said at the panel. "We think the proposal is a really important proposal to pay for a number of discrete services under the Medicare program—for virtual check-ins, for remote patient evaluation, for remote evaluation of patient-submitted images and things like that, as well as for professional consultation between physicians."
Of course, even if CMS clears the path for the Medicare program, private insurers may still lack the guidance they need to authorize services for its beneficiaries. Insurers want clear rules describing what they're allowed to pay for—something they may need Congress to clarify.
"We hope our colleagues in Congress will take some steps toward affirmatively advancing what we know to be the right thing," concluded Karen Rheuben, M.D., director of the University of Virginia Center for Telehealth, who led the panel.