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TELEHEALTH


fee schedule] by about 0.2 percent.” And because the agency has to maintain budget neutrality, CMS will be decreasing some other Medicare physician payments. It should also be noted that patients would also be required to pay a 20 percent cost-sharing charge for these visits. CMS stated, “We are aware that coinsurance can be a barrier for some beneficiaries, but we do not have the statutory authority to waive the coinsurance requirement.” Nonetheless, Sean Sullivan, an attor- ney in the healthcare practice group of Atlanta-based law firm Alston & Bird, does believe that over time, the reim- bursement changes, and the uptick in telehealth use that will result from them, will reduce overall healthcare costs in the U.S. “I’m positive of that,” says Sullivan, who points out that the cost of a patient going to the ER even once or twice a year can be exorbitant.


And as Nathaniel Lacktman, a partner with the law firm Foley & Lardner LLP, and chair of the firm’s telemedicine indus- try team, points out, every Medicare Part B service is subject to a 20 percent patient copay fee, and unlike Medicaid, Medicare is a benefit that is not contingent on a beneficiary’s financial situation. “We are talking about 20 percent of a $14 charge, which comes to less than $3. In return, the patient doesn’t have to take off work to [physically] walk in and get care. The patient can also get rapid feedback from


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Nowadays, “physicians get double and triple booked every day, spend half their time typing in the EHR [electronic health record], and might only have 5 to 10 minutes with each patient. It is not the experience they hoped for when in medi- cal school,” says Lacktman. “These new modalities and virtual care options that offer direct third-party reimbursement are a great thing for physicians. Virtual ser- vices can help reduce burnout and manage their throughput of patient volume. Plus, the patients are likely to be much more satisfied with the overall experience,” he adds.


What’s more, for some providers, the


reimbursement piece for every single tele- health encounter isn’t necessarily a deal breaker. Tallahassee Memorial’s Faison notes that her hospital has created certain workarounds such as including telehealth visits in bundled pay services. This way, there isn’t provider dependence on get- ting paid for each individual telehealth encounter, since they would already be incorporated into what the doctors are billing toward anyway, she explains. “The rules and regulations around reimburse- ment, and the operational aspect in gen- eral, could become too much of a headache to even try it. So for us, it was about finding opportunities where some of those barriers would not come into play,” says Faison.


A new path for remote patient monitoring


Nathaniel Lacktman


his or her treating physician for less than what Starbucks charges for a cup of coffee. I think that is a stellar value,” Lacktman asserts.


He also contends that for those physi- cians who don’t believe that $14 is enough of a reimbursement to move the needle, raising it to $24 or $34 would likely not change their minds either. Lacktman believes that there is a bigger picture to see anyway: although these new virtual visit codes sometimes pay providers less than in-person codes, it will free up more time with the patients who truly need the in-person consultations.


As the industry continues along its value- based care path, hospital and health system leaders are realizing that keeping their high-utilization patients—who often have multiple chronic conditions—out of the ER by leveraging virtual technol- ogy has a great promise to lower costs. Recently, KLAS Research partnered with the American Telemedicine Association (ATA) to examine remote patient monitor- ing (RPM) programs at different healthcare organizations, including hospitals, payers and home health agencies. As part of the report, KLAS Research spoke with 25 organizations using products from seven remote patient monitoring vendors about their experiences.


On Jan. 1, CMS went live with three new CPT codes for remote patient monitoring— a sub-sector of homecare telehealth that allows patients to use mobile medical devices and technology to gather their own data such as vital signs, weight, blood pres- sure and heart rate and send it to healthcare professionals—that now permit physicians to get reimbursed for certain instances in which they are collecting and interpreting this patient-generated health data. And according to the KLAS/ATA report, the potential for RPM to improve health outcomes is quite apparent, with heart


12 hcinnovationgroup.com | MAY/JUNE 2019


disease and chronic obstructive pulmo- nary disease (COPD) being the leading use cases. The research found that 38 percent of respondents said their RPM program reduced hospital admissions; 25 percent said it reduced hospital readmissions; and 25 percent said it reduced ER visits.


What’s next?


The telehealth experts interviewed for this piece firmly believe that both patients and providers are motivated to make virtual care a bigger part of their lives. In Florida, Faison says that “every year there has been an increase in the amount of providers participating and the amount of [virtual care] claims being processed. And I think it will keep growing because consumers are catching on. They are saying I don’t have to take off work to get a service; maybe I can just log onto my cell phone and get that same [care].”


Salgado, who notes that throughout the U.S., there are a very limited number of infectious disease specialists—which has led to the state’s public health depart- ment’s telehealth network being heavily utilized for consultations for hepatitis A, HIV, and tuberculosis—says she heard lots of discussion during the ATA Annual Conference in April about new and differ- ent ways telehealth can be utilized, from behavioral healthcare to dermatology ser- vices, to name a few.


“I think you will see even more dibbling and dabbling in the next year or two, and in the next three to four years, I think tele- medicine will be seen as another standard model of care, rather than a different way of delivering medicine,” she predicts. In the end, patients and providers are get- ting increasingly comfortable and familiar with using virtual technology for the delivery of healthcare, says Lacktman, who believes that regulators are also becoming more comfortable with it. Many realize it’s arbitrary to restrict physicians’ use of a specific technology, as telehealth is simply a tool through which physicians provide care.


“What we should really care about is maintaining standards of care in the qual- ity of medical services, not the technical modality through which medical services are delivered,” he says. “Indeed, we are seeing more medical boards become less proscriptive in their definitions and use cases for telemedicine. Everyone wants to maintain patient safety—that is para- mount—but we also need to foster an envi- ronment in which physicians feel comfort- able and confident to innovate, developing new and better ways to deliver healthcare.” Alston & Bird’s Sullivan adds, “The stigma of using technology and not being able to see your doctor face-to-face is starting to go away.” HI


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