Why Medicare’s Expanded Telehealth Reimbursement Matters

Wider access will provide mutual benefit for seniors and providers by expediting care and reducing costs.

Jonathan Karl is the director of healthcare sales at CDW.

More patients are about to benefit from the care and convenience of telemedicine.

In April, the Centers for Medicare & Medicaid Services finalized policies allowing Medicare Advantage plans to offer additional telehealth benefits by 2020. CMS Administrator Seema Verma called the move “a historic step in bringing innovative technology to Medicare beneficiaries” in a press release.

Because 34 percent of Medicare recipients are enrolled in Medicare Advantage plans — with numbers projected to increase by 11.5 percent this year — I’m encouraged by the news.

Not only does telehealth offer a bridge to treatment, especially for older patients with physical disabilities or who lack transportation, it can also help an organization’s bottom line. A 2019 telemedicine study published in the American Journal of Emergency Medicine found net cost savings range between $19 and $121 per visit.

“Telemedicine offers opportunities for significant savings,” Dr. Ana Maria Lopez, president of the American College of Physicians, told Medical Economics earlier this year. “There is a strong case to be made for its use to expand patient access to care and to reduce medical costs.”

Which is why the promise of reimbursement for a wider range of telehealth services could encourage more organizations to bolster their infrastructure as more Medicare Advantage patients choose virtual visits as part of their overall care.

Wider Telemedicine Access Marks Progress

It isn’t the first shift in practice. Original Medicare (also known as Medicare Part A and Medicare Part B) began paying for virtual check-ins by phone or video earlier this year — a welcome upgrade from past policy that limited the option to seniors in rural areas.

But those five- to 10-minute exchanges come with many restrictions. Original Medicare enrollees can’t use telehealth to help manage chronic conditions or receive urgent care, for example.

On the other hand, Medicare Advantage patients have already been able to access some telehealth services as part of their supplemental benefits. The new CMS rule will make it likelier that Medicare Advantage plans will offer additional telehealth benefits for even greater access.

Although specific applications haven’t been detailed, the potential is great.

Telemedicine has been crucial in providing healthcare services during natural disasters and connecting rural patients with a wider range of specialty care. It’s also a critical means of addressing mental health care in communities lacking psychiatrists.

DISCOVER: Five ways telehealth is taking modern healthcare to the next level.

Advance Telehealth to Serve More Patients

Although the CMS changes to Medicare Advantage reimbursement come at a moment when more health plans and medical specialties are embracing telemedicine, notable challenges remain.

A 2018 research letter published in JAMA notes that telehealth adoption is far from universal. But the letter, which cites data from privately insured and Medicaid Advantage enrollees, nonetheless reported double-digit annual growth between 2005 and 2017.

One finding noted in the letter underscores the necessity of expansion: A large majority (83 percent) of telehealth users were urban residents, a clear signal to legislators and insurers that patients needn’t live in a remote area to benefit from a wide array of virtual care services.

With the $38.3 billion global telemedicine market projected to more than triple by 2025, there’s plenty of momentum to support a continued expansion of telemedicine coverage for seniors.

The time to start making those connections is now.

This article is part of HealthTech’s MonITor blog series. Please join the discussion on Twitter by using #WellnessIT.