There’s no question this is a challenging period for the healthcare community.  The elderly population is increasing along with the general population, which means healthcare needs are also on the rise.  However, the country is also experiencing a physician shortage, making meeting current and future healthcare needs a challenge unless a solution is found.  Finding ways to leverage technology to increase access to healthcare professionals, improve patient outcomes, and create more efficient processes and services is a key to addressing the problem.

Telehealth and remote patient monitoring solutions are already gaining traction among patients and physicians because of their ability to give patients better access to the services they need, while optimizing use of physicians’ time and allowing them to serve more patients.  In fact, telehealth services are being used to treat a variety of conditions across many demographics.

But, telehealth isn’t growing as rapidly as it could, even as many physicians and patients are realizing its value.  Among the factors stunting growth is lack of regulation and ongoing reimbursement issues that are creating uncertainty.   But, the good news is that over the past year, regulatory activity has increased that will help drive increased telehealth adoption, including language included in the Bipartisan Budget Act of 2018.

Federal Regulation

The Bipartisan Budget Act of 2018 included stipulations that would increase Medicare coverage for telehealth related services, including:

  • Increasing convenience for Medicare Advantage enrollees through telehealth,
  • Providing Accountable Care Organizations (ACOs) the ability to expand the use of telehealth, and
  • Expanding the use of telehealth for individuals with stroke.

The Act includes provisions that would allow for stand-alone reimbursement for virtual visits, which would increase the use of video for patient-physician consultations, and is a continued effort on the Federal level to increase support for telehealth reimbursement and is designed to not only drive adoption, but encourage healthcare providers to participate in policy development.

State Regulation

States have taken steps over the past several years to expand telehealth reimbursement policies to include more types of telehealth services, broaden the definition of an originating site, and generally reduce restrictions that imposed barriers to widespread adoption.  According to the Center for Connected Health Policy (CCHP) 23 states limit what is considered an originating site (where the patient is located during a video consultation).  However, 6 states have eliminated their geographic requirements since 2013, and 10 states have explicitly added policy that allows patients’ homes as eligible originating sites.

Several states have introduced policy to expand telehealth coverage in specific situations.  For instance, Vermont has eliminated restrictions on provider types, now requiring only that patients be enrolled in Medicaid; Maine has softened policies on RPM reimbursement; Maryland now includes the patient’s home as an originating site for the hearing impaired, and Utah has added a private payer law specifically applicable to telepsychiatry.  Video is also being increasingly allowed for prescribing medication, including controlled substances in accordance with Federal guidelines, largely in response to the growing opioid epidemic.

In all, 49 states and the District of Columbia currently have at least some level of reimbursement for telehealth services.  While many limit reimbursement to live video consultations, 20 states include remote patient monitoring and 15 have included store-and-forward, while nine states reimburse for all three services.

While there is still a long way to go for telehealth reimbursement to come in line with traditional healthcare services, these are steps that will continue to increase the use of telehealth services.  As more patients and providers discover the benefits of telehealth, the pressure will grow for states and the Federal government to continue to loosen restrictions on telehealth coverage.