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Telemedicine Update: Family Physicians Surveyed on Telemedicine Use, See Lack of Insurance Reimbursement as a Barrier

November 13, 2015
by Heather Landi
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Many health plans would like to see CMS expand Medicare coverage of telemedicine and many states are working to remove policy barriers
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While only 15 percent of surveyed family physicians said they use telehealth services in their practice, the majority of physicians surveyed, both telehealth users and non-users, stated they believe that telehealth improves access to patients and continuity of care, according to a survey by the American Academy of Family Physicians and funded by Anthem.

According to the survey results, 87 percent of physicians who use telehealth services and 64 percent of non-users said they would use telehealth to connect patients to specialists if telehealth were available.

However, of the family physicians surveyed, the majority, including both those who use telehealth service and those that do not use it, indicated that they see barriers to using telehealth in their practice including the cost of equipment, lack of training and lack of reimbursement by insurers.

The Robert Graham Center for Policy Studies in Family medicine and Primary Care sent surveys to more than 5,000 randomly selected family physicians, with rural physicians intentionally oversampled, according to a survey report. The survey received a 31 percent response rate (1,557 family physicians) and the survey analyzed the practice characteristics of those who use telehealth compared to family physicians who do not.

Compared with non-users, family physicians who use telehealth are more likely to practice in a rural location, be younger, have practiced 10 or fewer years and employ an electronic health record (EHR) system. Almost half of telehealth users (49 percent) practice as part of an organization that is not physician owned, so an integrated health or hospital system, the survey found. More than half of a telehealth users reported using telehealth one to five time in the past year, while more than 23 percent reported using telehealth on more than 20 occasions. The family physicians who reported using telehealth services employed it for diagnoses or treatment (55 percent), chronic disease management (26 percent), follow-ups (21 percent) and second opinions (20 percent).

The survey report authors highlight that with the call for patient-centered, value-based care that offers improved access to services dominating health system changes, provider availability is emerging as a major challenge. “Access to health care providers is particularly problematic in underserved communities and rural areas in which 20 percent of the U.S. population resides, yet only 10 percent of physicians practice,” the survey authors stated.

Telemedicine is frequently cited as a potential strategy to enhance access to care and increase the quality and continuity of care.

Slightly more than one-fifth (21 percent) of the survey respondents who use telehealth services agreed with the following statement: “The current Medicare reimbursement rate is adequate to cover a telehealth appointment.”  Whereas, 55 percent of family physician who don’t use telehealth services and 43 percent of those who do use it reported that they believe reimbursement by insurers is a barrier to using telehealth services.

“The findings also suggest that telehealth is on the cusp of advancing from a tool used occasionally to a tool implemented on a routine basis. However, use of telehealth services will not become widely adopted until health systems are reformed to address barriers. Specifically, practice training and support need to be reformed to include telehealth education; technological platforms need to be updated with tools to support telehealth; reimbursement for telehealth services needs to be expanded; and licensing and credentialing need to be clarified to allow for interstate provision of telehealth services,” the survey report authors wrote.

On the payer side, the Alliance of Community Health Plans, which represents small community health plans, would like to see the Centers for Medicare and Medicaid (CMS) expand Medicare coverage of telehealth, according to an ACHP brief. Specifically, ACHP addresses that the Medicare fee-for-service program reimburses only those patient telehealth visits held at a medical facility in a rural area and covers only a limited set of remote monitoring technologies. “Consequently, Medicare Advantage (MA) plans must categorize most telehealth services as a supplemental benefit and are not allowed to include them in their bids,” the brief states.

The ACHP outlined a number of policy recommendations they would like to see CMS and Congress enact, including supporting state laws that allow the practice of telemedicine across state lines and to allow MA plans to cover telemedicine services.

“Telehealth is not a separate and distinct service, but rather a modality that enables providers to deliver already-covered care in a way that improves health and lowers the cost of care without increasing utilization,” the brief states.

And, according to an update from the American Telemedicine Association (ATA), several states are moving to remove policy barriers and provide opportunity for telemedicine advancement. Connecticut and Florida Medicaid agencies are meeting with stakeholders to develop strategies that expand coverage of telemedicine-provided services, the ATA reported.

Connecticut Medicaid currently does not cover any services via telehealth and the Connecticut Medicaid Rates for Home Health Working Group recently met to discuss Medicaid home health reimbursement of telehealth including remote patient monitoring, according to ATA.