Telehealth extending reach of PCPs

August 1, 2013

CMS has increased the number of telehealth services it will reimburse under Medicare

New Medicare codes to pay for non-face-to-face visits for patients could go into effect in 2015. A proposal released by the Centers for Medicare & Medicaid Services (CMS) last month details two codes for primary care physicians for wellness and preventive care services and an expansion of telehealth services.

One code would allow primary care physicians to bill Medicare for development and revision of plans of care, communication with other health professionals, and medical management over 90-day periods for patients with two or more chronic conditions. Patients would have to qualify through either an annual wellness visit or a preventive physical exam.

However, another code would expand the current list of billable telehealth services to include designated rural areas near urban areas with a shortage of PCPs.

The new proposed codes are proof that Medicare is placing more value on wellness and preventive services provided by primary care physicians, says Rene Quashie, senior counsel in the health and life sciences practice at Epstein Becker & Green, P.C.

“Many policymakers have concluded that [primary care physicians] will play a critical role of changing how healthcare will be delivered in the future in this country-especially as we transition from a fee-for-service environment to one rewarding quality and patient outcomes. This is especially true in the management and treatment of chronic conditions,” Quashie says, adding that expanding telehealth eligibility also shows Medicare's progression. “This is a response to increasing pressure by providers, patient groups, and other stakeholders to improve access to care in certain rural areas. And teleheath is a great way to bridge access.”

The proliferation of telehealth could help extend the reach of PCPs in terms of patient monitoring between office visits, collaborative consults with specialists and real-time assessments.

Telemedicine is gradually becoming an everyday part of medical practice for commercial plans as well as Medicare. For example, follow-up inpatient telehealth consultation codes for Medicare beneficiaries in hospitals and skill nursing facilities were introduced by CMS in 2013.

According to IMS Reearch, 308,000 patients around the world were monitored remotely by providers in 2012 for congestive heart failure, chronic obstructive pulmonary disease, diabetes, hypertension and mental health conditions. And the numbers are expected to reach as many as 1.8 million patients in just four years.

Jeff Cain, MD, president of the American Academy of Family Physicians (AAFP), says the new Medicare codes will help create a more equitable payment system for primary care physicians.

“Such changes demonstrate CMS’s intent to support primary care through policies that promote comprehensive and continuous care,” Cain says.

However, the Medicare sustainable rate growth (SGR) formula is still scheduled to reduce the physician payment rate starting January 2014.

“In light of the SGR’s mandate that CMS slash Medicare physician payment by 24.4%, these incremental increases do nothing to sustain primary medical care, much less build the primary care physician workforce.”

This article originally ran in Medical Economics and contains an update.