Telehealth Reimbursement Moves Toward Greater Parity

What, exactly, can providers expect to be reimbursed for when it comes to a virtual care or telehealth visit?

The answer can vary quite dramatically. As noted in the new American Telemedicine Association (ATA) report, 2019 State of the States Report: Coverage and Reimbursement, more states have expanded their telehealth coverage, allowing healthcare organizations to recoup payment for such services-at least since the organization’s prior survey on the matter published in 2017. In fact, the report noted that 40 states, as well as the District of Columbia, have adopted a more responsive reimbursement environment in the past two years.

Yet, despite such expansion, there is little convergence over how, where, and when providers can seek reimbursement in each state for their virtual care offerings. 

Ann Mond, chief executive officer of the ATA, said in a press release that their findings support the idea that there is an “increasing recognition of telehealth,” adding that the value seen from this kind of care can help inspire federal and state policy makers to make changes to further its reach in the future.

“Collectively, states are realizing the many benefits of telehealth and are implementing policies to advance utilization,” she said. “It’s clear that more states are adopting telehealth solutions, but some lack the authority or resources needed to fully deploy telehealth across the state.”

Ashraf Shehata, MS, MBA, a partner at KPMG’s Global Healthcare Center of Excellence, a healthcare-specific branch of the professional services firm, says this is not a surprise. But he adds that until there is more cohesive guidance regarding telehealth reimbursement, we won’t see the kind of adoption that can truly help transform care in a way that will help to improve outcomes and lower costs.

“It takes some time for healthcare organizations to figure out how to blend telehealth into their current care process,” he says. “And a lot of providers aren’t sure whether they should bother. I often hear, ‘Well, if I was reimbursed for X, Y, or Z, I’d do it.’ But with so much of reimbursement set up around in-person visits, it’s hard for, not only providers, but also for payers and regulatory agencies, to figure out what should be reimbursed.”

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Shehata says the good news is that CMS is starting to incrementally expand what they will cover on virtual care. And their leadership, he believes, will help other federal and state agencies consider moves that will offer friendlier reimbursement models. But while there have been many demonstration projects, showing the potential value of telehealth services both to patients and to healthcare organizations themselves, it’s still not clear what the payment models should be under what circumstances.

“Even back in 1997, Medicare was funding and reimbursing for some telehealth services,” he said. “Even as of last year, Medicare was reimbursing for live video conferencing under very specific circumstances. But it’s hard to think of all the scenarios where telehealth makes more sense, and how the billing model should work, when the field is still so focused on that in-person visit as the norm. There are so many different scenarios where telehealth could be of benefit-but it’s hard to know the rules and laws and the provider restrictions for any given area or scenario.”  

While the ATA report makes it clear that many in the industry are looking toward state and federal funding agencies to help promote broader telehealth expansion, Shehata says that technology vendors will have a strong role to play.

“With the cloud, there are so many more capabilities than we had before,” he says. “One of the big unknowns is how technology vendors will get into the telehealth space in the next few years. Right now, some of the technologies require a higher bandwidth or stationary capabilities. But as the technology gets better, I think that will also further uptake for organizations.”

And make no mistake, says Shehata, when it comes to telehealth, it’s not a matter of if but when regarding that uptake.

“More and more, consumers want to have telehealth options,” he says. “And while we will probably continue to see quite a bit of divergence in terms of offerings and reimbursement over the next decade, payer and provider organizations will start to align more, which will lead to incentives for telehealth becoming more common. Put it all together and we will see a further acceleration on the uptake of these technologies.”

Kayt Sukel is a science and health writer based outside Houston.