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Doctors Struggle to Find Value in Telehealth

Dr. Peter Weigel's efforts to adopt the Medicare CCM program for his patients illustrate the difference between potential and practical.

By Eric Wicklund

- To Dr. Peter Weigel, the telephone may be the most important mHealth tool he uses. Too bad he’s not getting reimbursed for it.

“All doctors use telehealth in some form with their patients just by getting on the phone and talking to them,” the Westfield, N.J.-based physician says. “But unlike lawyers, our routine phone calls aren’t billable.”

Last year, the Centers for Medicare & Medicaid Services took a step in that direction when they launched a chronic care management program – complete with its own CPT code – that reimburses providers who connect with their chronic disease patients outside the office. A physician could now receive as much as $42.60 per patient per month for 20 minutes of contact.

According to a primer developed by SmartCCM, a Dallas-based provider of turnkey management services for healthcare providers,"CPT 99490 reimbursement specifically incentivizes physicians to better manage patients with multiple chronic conditions, the 32 percent of our population that accounts for an overwhelming share of healthcare services such as prescriptions fills, home healthcare visits, office visits and the vast majority of general healthcare and Medicare spending as well."

"The 99490 Medicare guidelines cover 20 minutes of non-face-to-face chronic care management services per calendar month including establishing, implementing, revising and monitoring patients' care plans for patients with two or more chronic conditions," the primer continues. "The chronic conditions must be one of the CMS' observed 27 chronic conditions, must be expected to last for at least a year or until the death of the patient if that projected date is less than 12 months and, without proper management, the conditions must significantly jeopardize the patient's health, putting them at risk of functional decline, exacerbated health risks, or death."

READ MORE: GAO Report: Telehealth Troubles Tied to Reimbursement Barriers

Is it working? Various surveys have shown that a majority of physicians are interested in the CCM program, but many also wonder if it’s worth the time and effort.

“There’s only so much you can do with 20 minutes,” says Weigel. “It’s very limiting when you have to do it all yourself. You do all the advance work, prepare for the call, then get on the phone for one thing – and they have four more things that they want to talk about. And then when they’ve gotten off the phone they forget the answers to three of the questions they asked.”

This then leads to more conversations with a patient, perhaps by e-mail – a method of communication that carries its own security concerns and restrictions, and which can be difficult to measure in terms of the 20-minute threshold.

Weigel says large group practices and health systems might see the value in the CCM program, but smaller practices and independent physicians find it’s too much of a hassle, especially if it adds to their already-overstuffed workloads or prompts them to add staff. It also lends credence to surveys showing that so few solo doctors and small practices are embracing telehealth.

“But keeping in touch with patients is a good thing,” he says.

READ MORE: Examining the State of Medicaid Telehealth Reimbursement

Weigel chose another route. He’d signed up for Hello Health’s EHR platform roughly five years ago, and this past year jumped at the chance to try Hello Health’s Wellbox CCM service, which provides him with a call center that conducts chronic care phone calls each month and documents that data in his EHR. He now spends about five minutes per CCM patient per month reviewing and acting on the data collected by Wellbox.

“It’s another way to touch those patients in between office visits,” Weigel says.

"The benefit, aside from reimbursement, is in reaching out, calling in and checking on (patients) every month," Michelle McKamy, a licensed clinician and director of special projects for SmartCCM – which offers a service similar to Wellbox – told mHealth News last year. "It's important for the doctor to make that connection, because most of their chronic care patients won't even go to their annual wellness visits. It's important that the government is at least acknowledging that coordination is needed."

McKamy believes CMS will continue to move toward more acceptance of – and reimbursement for – telehealth. She’s not alone. Organizations like the American Telemedicine Association, which praised CMS for instituting 9940 but also sharply criticized the agency for making it complex and confusing, are lobbying for clearer guidelines and more CPT codes.

"A well-established and ever-growing body of clinical evidence suggests that interoperable remote monitoring improves care, reduces hospitalizations, helps avoid complications and improves satisfaction, especially for the chronically ill," the ATA and several groups wrote in a 2015 letter to CMS. "Use and provision of (remote patient monitoring) is restrained in Medicare by CMS' decision to provide no reimbursement for it. We urge CMS (and other federal payers) to (use) every opportunity to incorporate RPM and other proven eCare technology … to work towards a connected healthcare system."

READ MORE: 83% of Healthcare Orgs to Invest in Telehealth, mHealth Tools

Weigel agrees, saying he’s interested in secure e-mail services that enable him to communicate more frequently with his patients, as well as remote patient monitoring platforms that would help him keep track of his patients while they’re at home.

He doesn’t expect that to happen quickly, though.

“I think this is something that’s really going to have to go on for three or four years to figure out,” he says of the CCM program. “There’s a lot of value there; we just have to figure out how to find it.”


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