Telehealth facing pre-virus scaleback
Cynthia Peeters’ stomach started hurting in mid-February as COVID-19 began dominating the news.
By April, the pain was overwhelming, but she was too anxious about the virus to go to the doctor. Her gastroenterologist did a cellphone video visit with her and suggested a diet change. When it got worse last month, Dr. Christopher Ramos did another video call and told Peeters to come in for a colonoscopy.
The diagnosis: Colon cancer, caught just in time.
“If telehealth was not available, I fear that we would have gotten to her diagnosis too late, and the cancer would have spread,” said Dr. James Weber, CEO of Texas Digestive Disease Consultants, where Ramos works. “Telehealth access most certainly allowed us to take care of this patient and likely save her life.”
After federal regulators said Medicare would cover such phone and video telehealth visits starting March 1, major insurers followed as COVID-19 started to shut down much of the U.S. Weber was happy to be reimbursed as the chain lost money because patients were too scared to show up for screenings.
Now, as Texas shuts back down amid soaring COVID-19 cases, Weber and doctors across the now-hardest-hit states face insurers that are starting to back away from the widely embraced approach to doctor appointments. They are scaling back telehealth to pre-COVID levels, which were limited, resuming out-of-pocket payments and using time consuming prior authorizations which can deter doctors.
In early May, Blue Cross Blue Shield of Texas set the expiration date for telehealth expansion at May 31. It has moved the date three times since then, including twice in the last two weeks to an Aug. 31 expiration date.
Most other insurers plan to reduce coverage of the visits in September even though Medicare and Medicaid is expected to cover them far more generously through the end of the year.
Other insurers have also set and moved deadlines for when they will stop covering these remote visits and started charging co-payments and cost sharing again for many,
A 2017 study found the average cost of a telemedicine visit was $79, far less than $146 for a doctor’s office visit. However, the study may not reflect existing charges, with doctors often billing the same rates for virtual and inoffice visits. The amount a consumer pays out of pocket varies based on plan details such as co-pays, deductibles and cost-sharing requirements.
“A lot of my patients still don’t want to come in to my office,” said Dr. Paul Berggreen, a gastroenterologist who is president of Arizona Digestive Health. Older adults who might be more susceptible to COVID-19 complications in particular are staying home, he said. His practice is operating on reduced staff during the pandemic.
“We don’t know when this thing is going to end,” he said. “It seems like you would want to keep the telehealth channel open, particularly for the vulnerable populations.”
While virtual visits are popular, they tend to be shorter than in-person care. But clinics still pay for technology to support virtual care while maintaining facilities for in-person care.