At $49 a visit, the health systems hope people will see the value in reaching for their cellulars or their iPads when their throat is scratchy or their sinuses inflamed. After all, who really likes sitting in an emergency room or a clinic waiting room?
The challenge is getting the federal government to recognize the value in that and perhaps paying for it through its Medicare program, said Dr. Dan Heinemann, a chief medical officer with Sanford Health. Thus far that coverage is lagging.
“I think the frustration is the lack of recognition that this is truly a legitimate way to provide care for many of the conditions or needs of the Medicare-age population,” Heinemann said.
He gives an example. Say your mother is in a long-term care facility in Sioux Falls. She has dementia and is easily confused and agitated when her routine is disturbed. Once every 60 days, Medicare wants her seen by a physician to make sure her condition is stable. So she is bundled up if it’s winter and sent off to a doctor’s office with Wheelchair Express.
“Now she’s sitting in an exam room where there is lots of activity,” Heinemann said. “Now she sees me, she’s agitated and just not her calm self. Do I put her on a medication to calm her, that might make her dizzy or more likely to, say, fall?
“I mean, what if I had done a video visit with her when she’s in the environment that she’s most comfortable in, where she’s calm and collected, and I don’t have to do any medication changes? Don’t you think that would be an incredibly good thing for the patient?”
The obstacle isn’t Medicare, said Mandy Bell, eCare Quality and Innovation officer for Avera Health. It’s Congress that has to decide what is or isn’t covered, she said.
She thinks Medicare reimbursements could spur the use of telemedicine even more dramatically. By Avera’s way of thinking, the technology can provide better and more cost-effective care, Bell said. Using telemedicine to treat people in their hometown intensive care units can shorten the length of care, get them out of a hospital bed sooner and reduce the risk of hospital-related infections, she said.
“We even show that it saves lives,” Bell said. “We have reduced fatalities.”
But she also understands that Medicare and the government are trying to look out for beneficiaries and taxpayers “and to make sure what is being offered is cost effective.”
“So it’s incumbent on us,” Bell added, “to provide evidence that this is better care.”
Some health systems have voiced their disappointment that “21st-century cures” legislation winding its way through Congress is moving so slowly. The legislation would order the Centers for Medicare and Medicaid Services to draw up plans to pay Medicare benefits for telemedicine, though no action on the bill seems imminent.
“People are concerned that there’s going to be video mills set up just taking people’s money and billing Medicare inappropriately,” Heinemann said. “Are there those people out there? You bet. But I still think this is a very legitimate way to provide care for a number of conditions that makes sense.”
As for now, Medicare will not pay for cellphone, tablet, desktop or iPad visits because the patient isn’t in a provider’s office talking to another provider over a video screen, Bell said. Some private insurance companies will cover it, but Bell and Heinemann agreed that ultimately a decision by Medicare to pay for video visits and other telemedicine procedures is important because the government program sets the trend for private insurance markets.
It’s not just about pay, either, Heinemann said. Setting up a system so states recognize the licensing of providers from other states is another important key to the future of telemedicine.
Like Bell, he believes video visits and telemedicine will save money and potentially save lives. He also understands why Medicare is slow in coming around so far.
“As complex as Medicare is … it’s just going to take some time to work it’s way out,” he said. “Sometimes big systems, the federal system, struggles with being nimble around complex issues. I think that’s the situation here.”
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