Doc­tors give Medi­care’s pro­posal to pay for telemedicine poor prog­no­sis

Lodi News-Sentinel - - LOCAL/NATION - By Phil Gale­witz

The Trump ad­min­is­tra­tion wants Medi­care for the first time to em­brace telemedicine across the coun­try by pay­ing doc­tors $14 for a five-minute “check-in” phone call with their pa­tients.

But many physi­cians say the pro­posed re­im­burse­ment will cover a ser­vice they al­ready do for free. And the Medi­care re­im­burse­ment — in­tended to mo­ti­vate doc­tors to com­mu­ni­cate with pa­tients out­side the of­fice — could have a chill­ing ef­fect on pa­tients be­cause they would be re­quired to pay a 20 per­cent cost­shar­ing charge.

Medi­care said the call would be used to help pa­tients de­ter­mine whether they need to come in for an ap­point­ment. But doc­tors and con­sul­tants said the vir­tual ses­sions could cover a broad ar­ray of ser­vices, in­clud­ing mon­i­tor­ing pa­tients start­ing a new medicine or those try­ing to man­age chronic ill­nesses, such as di­a­betes. The Medi­care Pay­ment Ad­vi­sory Com­mis­sion, which pro­vides guid­ance to Congress, panned the pro­posal last month, say­ing it could lead to ex­cess spend­ing with­out ben­e­fit­ing pa­tients.

“Di­rect-to-con­sumer tele­health ser­vices ... ap­pear to ex­pand ac­cess, but at a po­ten­tially sig­nif­i­cant cost and with­out ev­i­dence of im­proved qual­ity,” the com­mis­sion’s chair­man, Dr. Fran­cis Crosson, said in a let­ter to the Cen­ters for Medi­care & Med­i­caid Ser­vices (CMS). “Due to their greater con­ve­nience, these ser­vices are at risk of mis­use by pa­tients or provider.”

Congress has shied away from ex­pand­ing the use of telemedicine in Medi­care — even as it has be­come com­mon­place among pri­vate in­sur­ers — be­cause of con­cerns about higher spend­ing. Bud­get hawks worry that rather than re­place com­par­a­tively ex­pen­sive in-per­son vis­its, ex­tra telemedicine billings would add to them.

Lack of cov­er­age — ex­cept in rare cir­cum­stances — means less than 1 per­cent of the 50 mil­lion Medi­care ben­e­fi­cia­ries use telemedicine ser­vices each year.

Fed­eral law for­bids Medi­care from pay­ing for telemedicine ser­vices that re­place in-per­son of­fice vis­its, ex­cept in cer­tain ru­ral ar­eas. That’s why CMS called the new ben­e­fit a check-in us­ing “vir­tual” or “com­mu­ni­ca­tions tech­nol­ogy,” said Ja­cob Harper, who spe­cial­izes in health is­sues at the law firm Mor­gan, Lewis & Bock­ius.

In ad­di­tion to the check-in call, CMS has pro­posed start­ing to pay physi­cians to re­view pho­tos that pa­tients text or email to them to eval­u­ate skin and eye prob­lems, as well as and other con­di­tions. It also has pro­posed pay­ing physi­cians an un­spec­i­fied fee for con­sult­ing elec­tron­i­cally or by phone with other doc­tors.

“In­no­va­tive tech­nol­ogy that en­ables re­mote ser­vices can ex­pand ac­cess to care and cre­ate more op­por­tu­ni­ties for pa­tients to ac­cess per­son­al­ized care man­age­ment as well as con­nect with their physi­cians quickly,” said CMS Ad­min­is­tra­tor Seema Verma when an­nounc­ing the pro­posal.

CMS said it hopes to en­act the changes in 2019. Of­fi­cials will an­nounce their fi­nal rule af­ter eval­u­at­ing pub­lic com­ments on the plan.

Verma and other CMS of­fi­cials say they be­lieve the change would end up sav­ing Medi­care money by re­duc­ing un­nec­es­sary of­fice vis­its and catch­ing health prob­lems early, be­fore they be­come more costly to treat.

But in its de­tailed pro­posal, CMS ac­knowl­edges the tele­health ser­vice will in­crease Medi­care costs. CMS said the tele­health will re­sult in “fewer than 1 mil­lion vis­its in the first year but will even­tu­ally re­sult in more than 19 mil­lion vis­its per year, ul­ti­mately in­creas­ing pay­ments un­der the (Medi­care physi­cian pay sched­ule) by about 0.2 per­cent,” or even­tu­ally about $180 mil­lion per year. Be­cause the change must be bud­get-neu­tral, CMS is pay­ing for this by de­creas­ing some other Medi­care physi­cian pay­ments.

CMS doesn’t ex­pect rapid adop­tion of the tele­health ser­vice, partly be­cause doc­tors can get paid from $35 to $150 for an in-per­son visit. “Be­cause of the low pay­ment rate rel­a­tive to that for an of­fice visit, we are as­sum­ing that us­age of these ser­vices will be rel­a­tively low,” CMS said in its pro­posal.


Cen­ters for Medi­care and Med­i­caid Ser­vices Ad­min­is­tra­tor Seema Verma on Jan­uary 10, 2017, in the lobby of Trump Tower in New York.

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