Despite the research showing the wide-reaching benefits of telemedicine, reimbursement for services still lag depending on which health plan you have and what state you live in, and particularly for those under government programs like Medicare.

That may soon change though, with new bipartisan legislation aiming to initiate a federal model for Medicare populations, expanding telemedicine services and coverage.

Telehealth Innovation and Improvement Act

Senators Cory Gardner (R-CO) and Gary Peters (D-MI) recently introduced the Telehealth Innovation and Improvement Act bill that, according to MobiHealth News, would require the Center for Medicare and Medicaid Innovation (CMMI) to test the effect of including telehealth services in Medicare health care delivery reform models.

The Department of Health and Human Services (HHS) would be required to allow eligible hospitals to test telemedicine services through CMMI, upon which, the HHS would direct CMMI to evaluate for cost, effectiveness and improved health care delivery, without increasing cost. “If the test telemedicine models can meet that set of criteria, a system-wide program will be established and covered through Medicare,” MobiHealth reported.

Telemedicine stands to benefit on a universal scale but its potential would be most significant for those in rural or underserved areas where access to care is sparse at best, as well as aging and low-income populations. Many in rural areas live hours away from healthcare services, with speciality care especially lacking.

“The Telehealth Innovation and Improvement Act would allow Medicare to expand coverage of telehealth services and increase access for people living in rural America. It would also incentivize the healthcare industry to develop new technologies that could potentially reduce costs and improve patient health,” said Senator Gardner.

Payer uncertainty prohibits telemedicine expansion

According to the American Telemedicine Association (ATA) “report card”, which looks at policies related to coverage and reimbursement on a state-by-state level, telemedicine implementation is progressing overall.

According to Latoya Thomas, director of the ATA’s State Policy Resource Center, “There is promising news overall for patients, providers, and businesses using telemedicine and other digital health platforms. These reports show that insurers, state lawmakers and Medicaid agencies see telemedicine, and other digital health platforms, as affordable and convenient solutions to bridge the provider shortage gap and enhance access to quality health care services.”

But there are still barriers prohibiting a wider utilization of telemedicine’s capabilities. All Medicaid agencies cover some form of telemedicine but reimbursement varies by state, and discouragingly, many commercial payers only cover a small range of services. Medicare coverage is the most limited with rules and requirements that exclude many telemedicine services.

Natasa Sokolovich, executive director of the University of Pittsburgh Medical Center’s telehealth program, says reimbursement is the biggest challenge. “Most insurers have the fear that allowing reimbursement for telehealth would somehow open up the floodgates [for care] or lead to abuse.”

Researchers, payers and providers are in the process of finding out what works, what doesn’t, and how best to utilize telemedicine to receive its maximum benefits. A recent story indicated that many employers provide telemedicine options to employees for minor ailments—employees not having to leave or miss work to see a doctor is seen as a return on investment, which is a start. However, many feel employers and payers need to expand their coverage policies in order for telemedicines potential to be fully met. “The people who might benefit the most from telemedicine are the people not allowed to use it,” says Roy Schoenberg, MD, CEO of American Well.

Telemedicine advances despite roadblocks

Despite barriers, the support for telemedicine is growing as evidenced by the bipartisan efforts behind the Telehealth Innovation and Improvement Act bill as well as additional support from many key political figures such as HHS Secretary Tom Price who has endorsed telemedicine in the past.

The data proves compelling as well. Most recently, a report commissioned by the Centers for Medicare and Medicaid Services found that initiating a telehealth program, in this case, an eICU program at Emory Healthcare, can reduce hospital readmissions and save million of dollars.

The goal of the program, as reported by MobiHealth News, was to expand critical care services which have been hit especially hard by the nationwide shortage of specialists. “According to the report, the telehealth technology saved Emory $4.6 million  – or $1,486 in Medicare spending per patient,” reported MobiHealth News. The greatest benefit being “the ability for specialists to quickly respond and intervene at dangerous situations during the night rather than waiting for the regular ICU doctors to return in the morning.”  

Overall, the scope and future of telemedicine may be contingent upon what payers are willing to cover. However, as the research in support of telemedicine continues to showcase its many benefits and progress builds across the political spectrum, we expect to see coverage continue to expand, creating wider access for the many Americans who stand to benefit from it most.