Virtual Visits Gaining Ground

Telehealth services are in-demand and, quite literally, on-demand. Patients are increasingly seeking out health services via real-time synchronous audio-video encounters with health care providers (known as “telehealth” or “telemedicine”). The availability of on-demand virtual doctor visits via telehealth reverses the longstanding paradigm of placing the burden on patients to seek care where it’s physically available. Telehealth is also in-demand as evidenced by recent private payer, federal and state activity aimed at increasing access to and use of telehealth services.

Congress Takes Up Telehealth

Telehealth services and the rules governing the reimbursement of such services have been a hot topic on Capitol Hill in recent weeks.

21^st Century Cures. Federal policies to encourage telemedicine services have been included in a legislative effort, entitled the 21^st Century Cures initiative, currently underway in the U.S. House Energy and Commerce Committee. Over the course of last year, the Committee held several hearings, roundtable discussions and issued white papers on a variety of issues concerning the modernization of the discovery, development and delivery of medicine. Those activities included a hearing specifically on digital health care last summer that examined the uses of telemedicine and what’s needed to more widely facilitate telemedicine services in the future.

In January 2015, the Energy & Commerce Committee issued an initial legislative draft of the 21^st Century Cures bill that contains a provision that would create a list of telemedicine services that would be covered by Medicare and required budget neutrality for all of those newly covered services. However, that initial draft was recently revised, and the telemedicine provision was removed and replaced by placeholder language stating that further work is needed to include a provision on telemedicine services. While the removal of that language is a setback for crafting policies that would encourage the use of telemedicine, the fact that the provision still has a potential place in the bill is encouraging, as compared to other provisions that were simply cut out. During the coming weeks, the Energy and Commerce Committee will attempt to finalize language on telemedicine before the bill moves out of the Committee to be considered by the full House of Representatives.

More House Action. Separate legislative efforts outside the 21^st Century Cures effort are also underway. Rep. Gregg Harper (R-MS) introduced a bill that promotes and expands the application of telehealth under Medicare and other Federal health care programs. Rep. Harper’s telehealth legislation builds off a previous bill, the Telehealth Enhancement Act of 2013, which sought to adjust Medicare home health payments to account for remote patient monitoring and to expand coverage to all critical access and sole community hospitals. Additionally, Rep. Doris Matsui (D-CA) introduced legislation earlier this year that calls for states to authorize health care professionals to deliver health care to individuals through telemedicine.

Senate Hearing and Legislation. On April 28, 2015, the U.S. Senate Committee on Commerce, Science and Transportation's Subcommittee on Communications, Technology, Innovation and the Internet held a hearing to examine how the use of telehealth has helped lower costs and improve patient outcomes. The hearing, entitled “Advancing Telehealth through Connectivity,” explored a wide variety of issues, including provider licensure issues, the role of the Federal Communications Commission to enable and promote telehealth services, and provider reimbursement limitations. Subcommittee members generally seemed to favor increasing use of telehealth, with many of the lawmakers calling on Medicare to reimburse for such services.

During the hearing, Subcommittee Chairman Roger Wicker (R-MS) announced plans to reintroduce, with Senator Thad Cochran (R-MS), a bill that would extend Medicare coverage for telehealth services provided in underserved areas. The Telehealth Advancement Act aims to bring parity in payment and help improve Medicare reimbursement. The bill was introduced but not voted on during the 113^th Congress.

All this in just two weeks’ time! These recent actions evidence that federal lawmakers are becoming more proactive in their pursuit of telehealth polices that will both shape the manner in which services are delivered and how those services will be paid for.

States Remain Active, Attentive

On April 10, 2015, the Texas Medical Board voted to change the practice of telehealth in that State. The Board clarified that a physician-patient relationship can be established through a “face-to-face” visit held either in person or via telemedicine. Citing patient safety, the Board explained that “Essentially the only scenario prohibited in Texas is one in which a physician treats an unknown patient using telemedicine, without any objective diagnostic data, and no ability to follow up with the patient.” Many expect the Texas Medical Board’s vote to be challenged in court.

On April 17, 2015, Washington State’s Governor signed a bill expanding coverage for telemedicine services paid for by certain health plans in the State of Washington, becoming the 24^th state to adopt a full or partial telemedicine “parity” law. Generally, parity laws require health care payers to cover services furnished electronically to the same extent such services would be covered if furnished in a face-to-face visit. Although the new law requires parity in coverage, it does not require parity in reimbursement. The new Washington State parity law received strong support in both Washington legislative houses.

On April 25, 2015, a panel of experts explored “Trends and Developments in Telemedicine” as part of the Federation of State Medical Boards’ Annual Meeting in Fort Worth, Texas. Speakers discussed how providers and patients are using emerging technologies to improve health outcomes, online prescribing and medication dispensing issues, and the Federation’s “Model Guidelines for the Appropriate Use of Telemedicine Technologies in the Practice of Medicine.”

Private Payers Recognize Telehealth

In the last week of April 2015, UnitedHealthcare, the largest health insurer in the U.S., announced a significant new coverage decision to include virtual visits through the popular Internet-based platforms Doctor on Demand, American Well’s AmWell and Optum’s NowClinic. These companies allow for a physician consultation in real-time, as well as writing a prescription for common conditions like the flu, pinkeye, UTIs, sinus infections and bronchitis. This new coverage decision is currently available to UnitedHealthcare’s self-funded employers. UnitedHealthcare announced plans to expand telehealth coverage to employer-sponsored and individual plan participants in 2016.

Conclusion

Given the potential of telehealth to improve access to care while reducing costs and increasing patient and provider convenience, interest in and use of telehealth is only expected to grow in the months and years ahead. The adage is increasingly true; the doctor will see you now.