The World Has Recognized That Telehealth Is the Future of Healthcare: The Big, Unanswered Question Is How We Pay For It

By Tom Conroy, CEO and co-founder, MedSign.

Tom Conroy

The telehealth market is expected to reach $10 billion this year, which represents a 80% jump in growth. Much of this has been driven by the coronavirus and, prior to the pandemic, as a response to skyrocketing healthcare costs.

Current safety concerns surrounding at-risk patients visiting hospitals and other healthcare facilities have increased the urgency for solutions that provide critical medical support while mitigating risk.

Lawmakers have responded by relaxing antiquated rules and policies limiting telemedicine access that would otherwise have required decades of debate and lobbying efforts to change. This conversation has also created renewed interest in Telehealth as one answer to the growing healthcare crisis in this country.

That all represents significant progress, however there is still one big, unanswered question: How to address billing and insurance coverage issues.

Back in April, politicians, media and influencers were widely cited as saying patients were covered for Telehealth services. However, many telehealth patients were still getting billed. This was largely because of the fact that payer groups including the government, insurance companies and private enterprise “didn’t get the memo” or were slow to change their policies. In essence, without the participation of these payer groups, the promise of Telehealth was empty.

As a result, millions have been denied access to cost-effective solutions that also ensure patients are safe and secure from Coronavirus and other issues. This is unacceptable. If we are truly committed to delivering quality medical care online, then the healthcare community, our legislators and patients must demand a standard telehealth reimbursement and billing system for all — no matter who you are or what insurance you have.

Today, the big insurance carriers (BCBS, Aetna, Cigna, United Healthcare) cover Telehealth, but since there is no set standard for private health insurance companies, billing has been haphazard, reimbursement spotty and confidence low. Given the challenges of the growing pandemic, this is dangerous and in some cases punitive.

There are many opinions out there about how we need to  address billing and reimbursement for telehealth services, but prevailing wisdom appears to be repeating the mistakes that plague our traditional healthcare system and have heaped undue financial burdens on Americans. That would be an enormous missed opportunity to repair one of the most broken parts of our healthcare system.

While the Centers for Medicare & Medicaid Services (CMS) acted quickly to remove barriers, eliminating coinsurance and allowing patients to receive virtual care in their homes to minimize the COVID-19 risk , there is still work to be done.

Medicare is moving swiftly with a strategy to provide payment using specific CPT and HCPCS codes, but most of these Telehealth sessions require the use of a smartphone, tablet, or computer. This is a tremendous barrier to those patients that are technology averse patients, especially the elderly, the poor, disadvantaged, and underprivileged.

We have an opportunity with Telehealth to rethink our approach and create a system that really works in the best interests of all parties. An appropriate solution provides access to vulnerable patients and others, thereby reducing costs associated with additional illness due to exposure to Coronavirus.

Other preventative care costs are also mitigated for patients who benefit from more frequent interactions, improved support from friends and family and reduced travel expenses. For provider groups, physicians can see more patients more efficiently, improve the preventative quality of care and focus on the health of patients most at risk. Payer groups should see costs go down significantly, as preventative measures decrease or slow the most expensive chronic and progressive diseases.

Telehealth is the future of how we support our most at-risk and most difficult to reach communities, and we must make sure that it is indeed accessible both logistically and financially.

The Coronavirus pandemic has created an opportunity to right the wrongs of our current healthcare system and address new issues as they arise (for example, telehealth employs many out of work doctors who are otherwise unable to continue regular practice because of limitations imposed by the response to Coronavirus). Telehealth has made a big difference, and for it to continue to perform well and bring meaningful change, one big step to take is transparency in billing and consistent insurance coverage.

Telehealth should be a universal service for every American and it should include Medicare codes to support both equipment and services. Coronavirus has brought many healthcare challenges to the forefront of the national agenda, and has given us a chance to be smarter and even undo the mistakes of previous healthcare reform bills. This will ensure that Americans have access to quality and convenient care. If you believe that Telehealth services should be covered by all insurances, then take action. Call your local officials, let your insurance provider know, and talk to your doctor.

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