Medicare is poised to expand access
to telehealth services to rural patients across the U.S. Telehealth makes it easier for both rural and urban patients to visit the doctor, but the Congressional Budget Office isn't sure whether fully covering these services would raise or lower healthcare costs. Dickson Ozenna of Nome, Alaska, meets with Tzu-Ching Liu, a nurse practitioner with the cardiology department at the Alaska Native Medical Center in Anchorage. Norton Sound Health Corporation
Clifford Seetook lives in Wales, Alaska, a town of only about 150 permanent residents on the state's western lip. When the 62-year-old retired custodian began feeling pain in his hip and knee last spring, he visited the village's clinic for physical therapy because "you've got to keep moving," he says.
But there wasn't a physical therapist within a hundred miles, and a round-trip flight to Fairbanks or Anchorage costs about $1,000. So a health aide helped him log on to a virtual office visit with a physical therapist based in Nome. Seetook learned exercises over six online sessions and managed his pain well enough to remain at home while awaiting surgery this fall.
"It made things a lot easier for myself and the physical therapist to communicate," he says. "That gave me a lot of courage."
For decades, proponents of telehealth, also known as telemedicine, have pushed for the expanded use of communications technology to deliver healthcare services to underserved areas -- both urban and rural -- to help patients like Seetook. In its various forms, telehealth has been shown to expand access to care, reduce wait times for appointments, lower the cost of healthcare and improve patients' health. Analysts at Towers Watson have predicted that U.S. companies could save as much as $6 billion in healthcare costs if all employees used telehealth coverage to the greatest possible extent. However, supporters have struggled to persuade insurers and government healthcare programs -- especially Medicare, the nation's healthcare insurance for people who are at least 65 years old -- to cover these services at rates comparable to those physicians receive for treating patients through traditional visits.
"The goal of telemedicine is to get healthcare out to where the person is," says Jonathan Linkous, CEO of the American Telemedicine Association, a group that estimates roughly 12 million Americans used some form of telehealth in 2013. Linkous suspects the number has doubled since then.
Medicare only covers telehealth for a limited number of patients in designated rural areas, and those patients must still travel to a clinic to complete a session rather than log in directly from home. As a result, only 1 percent of Medicare beneficiaries use telehealth each year.
And since Medicare coverage is used as a benchmark for grant funding and private insurers to set their own rates, investment has been limited since telehealth debuted in the 1990s.
"How do you expect a provider to provide these services through telehealth if they don't get paid for it?" Mei Wa Kwong, senior policy associate at the Center for Connected Health Policy, says. "It kind of holds it back."
But that may soon change, as multiple federal campaigns aim to relax Medicare's restrictions and provide patients with greater access to telehealth services. If successful, these changes could have a domino effect by demonstrating the value of these services more broadly as support for telehealth builds in the private sector and among consumers.
Telehealth is a vague term -- the federal government has seven definitions for it -- but in its most popular form, a patient consults a doctor about a rash or sore throat over a quick video consultation. The American Telemedicine Association estimates at least 450,000 patients have engaged in 800,000 online doctors visits in the past year.
In other instances, telehealth means installing monitoring equipment in the home of a patient with heart failure so that doctors can keep an eye on their weight – a sudden change can indicate fluid buildup. It can also mean having a nurse use a portable device to take a patient’s blood pressure at a rural clinic and forward that data to a physician (a practice known as “store and forward”).
The Centers for Medicare and Medicaid Services has proposed expanding Medicare coverage of telehealth services to permit rural health clinics and qualified healthcare centers to use technology to monitor and manage patients with chronic diseases such as end-stage renal failure in their own homes. The revision, which is under review, stopped short of expanding coverage to all Medicare beneficiaries regardless of location, or of permitting in-home video consultations.
Legislators in the House and Senate introduced an act this summer to pay physicians for telehealth delivered to Medicare beneficiaries in any location, to include physical therapists and speech language pathologists among the clinicians eligible for reimbursement and to permit physicians to treat patients from other states without physically meeting them first. Last month, 21 organizations including the American Telemedicine Association and the U.S. Chamber of Commerce co-signed a letter in support of the act, though previous versions failed to gain much traction in Congress.
These measures at least indicate burgeoning interest at the federal level in incorporating telehealth more broadly into the healthcare system. In the private sector, momentum is building more rapidly. This year, UnitedHealthcare pledged to provide clients 24-hour access to video visits for conditions such as allergies, bladder infections and bronchitis through their laptops or phones. Walgreens announced it would offer similar access to customers in 25 states through Walgreens.com, while CVS is conducting pilot tests to provide telehealth to customers through its nationwide network of MinuteClinics. The pharmacy chain is working with a startup called Teladoc, which employs 700 physicians and went public in July.
Doctors and hospitals are embracing the idea, too. The Cleveland Clinic and University of Washington Medical Center have both started online clinics this year where residents of Ohio and Washington pay less than $50 for a virtual visit for colds, the flu, sore throats and urinary tract infections.
life is way too important to take seriously
