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TELEMEDICINE AND THE MEDICAID DILEMMA

 

Saturday, June 4:

We are a technology-dependent society.  We use our smart phones, tablets, and other devices to quickly and easily access information, engage in financial transactions, and perform vital job functions. Healthcare providers have used advances in technology to enhance patient care.  A doctor at a huge metropolitan hospital in an urban area can now see and treat, in real time, a patient at a rural site hundreds of miles away.  In a miracle of modern medicine, even patients in remote areas can thereby receive cutting edge treatments.

But there is a problem.  As the applications of technology and the skills of its users advance, the payment system sometimes fails to keep up.  While many states have laws providing that telemedicine should be paid for just like face-to-face services, because that is essentially what telemedicine is, some payors don’t yet have codes that cover these services. 

Changing Medicaid reimbursement and updating Medicaid fee schedules has been likened to turning the Titanic.  Provider skills and the practice of medicine advance quickly, driven by patient needs and the available tools.  Patient care does not suffer, because providers are quick to use new abilities to better treat people.  Rather, it is the providers who suffer.  A doctor is unwilling to require a fragile patient to leave her home and drive hours to the hospital for a required check-in visit when she can simply use a smartphone or computer to best treat her.  So the doctor does what is best for her patient, and simply goes unreimbursed for those services.  That is not the intent of the law, and it shouldn’t happen.

In 2015 the Center for Medicare & Medicaid Services (CMS) added seven new telemedicine billing codes to the physician fee schedule. The new codes include those for prolonged office visits, psychotherapy, and annual wellness visits. The CMS has also added a new Current Procedural Terminology (CPT) service code, 99490 for chronic care patient management in the final rule. This code is not a telehealth code and it can be bundled with the existing CPT code 99091 for collecting and reviewing patient data that does not require the beneficiary to be present; though, the CMS will still not allow any additional payments for this service.

While CMS has expanded Medicare coverage for telemedicine as long as the services are provided in a hospital or SNF setting, see: https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/TelehealthSrvcsfctsht.pdfstate Medicaid coverage has not always kept up with these changes.  And even CMS won’t pay for direct to patient services, where the patient is at a location other than a hospital.

Telehealth treats patients in real time, where they are located.  That is simply good medicine.  We need to work with payors, particularly state Medicaid departments, to make sure that providers can be paid for all the work they do and that codes exist to make this possible.  That’s the best way to keep medicine moving forward, particularly for our state’s most vulnerable citizens, the Medicaid and Medicare population.