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Survey: No Reimbursement, No Telehealth

An analysis of a 2014 AAFP survey finds that family practices aren't using telehealth because payers - both federal and private - aren't compensating them for it.

By Eric Wicklund

- Primary care physicians aren’t using telehealth because they aren’t reimbursed for it.

That’s the gist of a survey of about 550 family physicians, conducted in 2014, which found doctors staying away from the technology because Medicare and many commercial payers aren’t paying for it.  

"Payment is not aligned with services yet," Megan Coffman, MS, a researcher for the Robert Graham Center for Policy Studies in Family Medicine and Primary Care, recently told AAFP News. "We have to find different ways to incentivize rural providers to use it, and not just through fee-for-service."

Coffman led the study, published in the July-August issue of the Journal of the American Board of Family Medicine. The study was based on a survey conducted by the American Academy of Family Physicians (AAFP).

According to the Graham Center study, physicians working in federally designated safety net clinics (28 percent to 15 percent) or HMOs (19 percent to 11 percent) were more likely to use telehealth than not use telehealth.

However, those working in accountable care organizations (22 percent to 28 percent) were more likely not to use telehealth than to use it, and those working in patient-centered medical homes (31 percent to 29.5 percent) were almost evenly divided.

Overall, the AAFP study reported that only 15 percent of family care physicians surveyed in 2014 had used telehealth during the previous year.

Coffman said physicians generally don’t see a difference in quality between in-person visits and telehealth sessions, so they’re not adopting the technology. The difference lies in HMOs and FQHCs, where reimbursements are more likely to be tied to reduced hospitalizations.

While the AAFP study may be two years old – private payers and Medicare are starting to reimburse for some telehealth services now – it still points to the need for more payment reforms. The AAFP recently criticized the Centers for Medicare & Medicaid for not being more responsive to telehealth in its proposed 2017 Medicare physician fee schedule, and organizations like the American Medical Association, American Telehealth Association, American Hospital Association and the Health Information and Management Systems Society have voiced their support for policies that promote telehealth and improve physician reimbursements.

At its annual conference earlier this year, the Health Information and Management Systems Society (HIMSS) released a survey showing that some 80 percent of health systems are using some form of connected health technology, and more than 40 percent expect to save money with the technology.

“The healthcare ecosystem is increasingly converging on patient centric technology solutions,” Tom Martin, PhD, HIMSS director of Healthcare Information Systems, said as the survey was released. “The role of the provider is to expand far beyond the walls of the exam room, especially as our healthcare system transitions towards value based purchasing. The (2016 HIMSS Connected Health Survey) findings illustrate the importance of interactive relationships between physicians and individuals and technology as a means to advance comprehensive health and healthcare.”

Both the ATA and the Center for Connected Health Policy have issued reports this year criticizing the patchwork of state telehealth and Medicaid reimbursement policies, noting that some states allow far more than others.

“The spectrum ranges from a Medicaid program in a state like Connecticut, which will only reimburse for case management behavioral health services for clients under the age of 18, to states like California, which reimburses for live video across a wide variety of medical specialties,” the CCHP report, issued in April, said.

The ATA report, meanwhile, offered good and bad news.

“Over the past four years the number of states with telemedicine parity laws – that require private insurers to cover telemedicine-provided services comparable to that of in-person – has doubled,” the report noted. “Moreover, Medicaid agencies are developing innovative ways to use telemedicine in their payment and delivery reforms resulting in 48 state Medicaid agencies with some type of coverage for telemedicine provided-services.”

However, the report added, “(w)hile there are some states with exemplary telemedicine policies, lack of enforcement and general awareness have led to a lag in provider participation. Ultimately these pioneering telemedicine reforms have trouble reaching their true potential.”

Dig Deeper:

The Long and Winding Path to Telemedicine Reimbursement

Telehealth Growth, Savings Tied to Parity Laws

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