Cost reimbursement rules chill gains in telemedicine

Telemedicine continues to be a needed tool for healthcare providers to connect with patients, but regulations on cost reimbursements is still one of its biggest challenges for the technology to thrive, leaders of two of the biggest hospital systems in South Florida say.

Within Jackson Memorial Hospital’s private practices, about 25% to 30% of doctor-patient appointments are conducted through telehealth, said Javier Gutierrez, associate vice president of business operations and contract management from the Ambulatory and Physician Services Division at Jackson Health System. “Where you see it the most is with folks who are a little bit younger; a population willing to do more telemedicine than, perhaps, an older population who has a preference for coming in to the doctor, who may not have access to the technology that’s required, or who may have language barriers.”

 

Follow-ups that do not require physical exams, post-operative visits and behavioral health appointments are the leading types of services conducted by telemedicine, said Mr. Gutierrez. “In terms of who’s using it, primary care is actively using it; our surgical specialties, bariatric surgery (weight loss surgery), and general surgery are actively using it.”

Jackson Memorial Hospital for the most part, he said, tends to offer telemedicine “to anybody that would want it. I think our use of telemedicine becomes limited based on whether the payers are paying for telemedicine. If there’s no reimbursement associated with telemedicine… we wouldn’t be doing it.”

The federal government has extended the temporary telehealth services Medicare reimbursement of the Covid-19 Public Health Emergency declaration through the end of the calendar year 2023.

“The extended use [of telemedicine] towards the Covid-19 emergency period is in the books again this year in 2023,” said Mr. Gutierrez. “We’re going to be able to continue doing telemedicine as we’ve been doing it in the past. The federal government is still evaluating the quality behind telemedicine and the payment structure behind telemedicine before we see any substantial changes. I do expect, though, the payment, the reimbursement, to come down.”

Miami Lakes Rep. Tom Fabricio proposed a bill to the Florida Legislature that would allow the use of telephone calls in proving telehealth. This bill is to be filed for the 2023 session beginning March. Under current law, the definition of telehealth excludes audio-only telephone calls. The definition would continue to exclude email messages and faxes.

“That’s a way of providing access to some folks who may not have the technology for the video,” said Mr. Gutierrez. “That will improve follow-up communication with your doctor.”

However, he said, if the reimbursement is not associated with voice-only telehealth, “then you may not see the adoption. At the end of the day, [medical practice owners] are running businesses, so, unless you tie the dollars or the incentives into telemedicine, most doctors are going to prefer to perform care for their patients in a way that maximizes – unfortunately – their personal gain.”

Baptist Health South Florida’s Care on Demand platform, launched in 2016, provides virtual access to licensed doctors for non-emergency care using telehealth technology.

“We started with very slow adoption, and what we’ve seen is that, since the pandemic, and continuing, we are now seeing more consistent use of our platform on a daily basis, to the point now where we really have our own Baptist clinical team day in and day out that services the platform,” said Dr. David R. Mishkin, medical director of Baptist Health Care on Demand.

Before the pandemic started, he said, telehealth covered fewer than 1% of outpatient visits. “Now, what we’re seeing more consistently is about 10% of all outpatient visits are through telehealth.”

Now more of a mainstay type of healthcare, telehealth is becoming a go-to for patients to seek care for non-emergency matters, said Dr. Mishkin.

Behavioral health services are also the top specialty in telehealth adoption. “Close to 60% of national visits that fall in outpatient visits for behavioral health are being seen in platforms, and I think that there’s a lot of potential in that as well.”