Telehealth reimbursement uncertainty creating inequities in healthcare

Telehealth consultation
Telehealth applications like e-consultations are going mainstream, but without fixes on reimbursement, only the rich can afford them. (Getty/AndreyPopov)

Telehealth tools have been around for years now, so the biggest roadblocks to receiving remote care aren't technical—they're payment-related.

That issue took center stage on Thursday as a panel of healthcare stakeholders urged CMS to take the lead in solving telemedicine's reimbursement dilemma. 

"If [telehealth] doesn't get reimbursed, it doesn't get done," said Jeffery Smith, vice president of public policy at the American Medical Informatics Association (AMIA), who moderated the panel. "I think that is a harsh reality to face."

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"Certainly, we could point to all kinds of pilots and we can point to all kinds of little flowers that have been planted, but in order to raise the national adoption rate, we have to reimburse it," he added. "And CMS, as the only national payer, is kind of on the hook to do this."

That issue is also further antagonizing another dilemma around healthcare inequality. Several experts on the panel warned that reimbursement hurdles would further the gap between those patients that can afford the out-of-pocket cost of a telehealth visit and those that can't.  

RELATED: Teladoc CEO: Medicare telehealth proposal paves the way for long-term expansion

More providers are offering some sort of telemedicine or remote monitoring service. While some payers have begun partnering with telehealth vendors, many plans have no reimbursement schedule at all for telehealth.

Depending on their coverage, a patient may be effectively barred from these programs unless they are willing to pay out of pocket.

"I actually worry that it's creating more health disparities at the moment," said Victoria Tiase, director of informatics strategy at NewYork-Presbyterian Hospital. "Because what we're seeing in New York City, since it's not being paid for, we see it's just patients that can afford to pay the extra to get their telehealth and telehealth visits taken care of. So I think a closer look at that is really important before we start widening the gap."

In some ways, New York may have the worst of it. Most of the attention in telehealth has gone toward rural areas, where patients may be hundreds of miles from any provider, let alone the specialist they need.

RELATED: Telehealth’s economic impact could have broad reach in rural communities

But the winds may be shifting on that. In mid-July, CMS issued a national proposed rule that included some new codes for virtual interactions and remote monitoring. Speakers at the panel clearly wanted CMS to take further action in that direction—creating robust procedures for telehealth beyond just the rural locations and healthcare facilities in which they are currently installed.

Theresa Cullen, M.D., associate director of global health informatics at the Regenstrief Institute, said CMS has traditionally fallen short when it comes to incentivizing providers to offer care outside of the hospital, which can be a key solution to resolving healthcare inequalities. 

The panel was hosted by AMIA and the HIMSS Foundation’s Institute for e-Health Policy at the Dirksen Senate office building. Additional speakers included David Liebovitz, M.D., chief medical information officer at University of Chicago Medicine, Christina Caraballo, co-founder and COO of Kizmet Health, and Thomas Agresta, M.D., director of medical informatics in family medicine at UConn Health.

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