The Rise of Telemedicine

With the rapid advancements we are seeing in the healthcare and medical industries, telemedicine has become a relevant method of patient consultation. Telemedicine, which has been around for over a decade, initially received skeptical views. Many questioned its validity as a thorough alternative to actually coming in to see a medical professional. Now, it is poised to reinvent how we view patient consultations. According to a Cisco Customer Experience Report, the number of telemedicine patients will go from a recorded 350,000 in 2013 to 7 million in 2018. However, many doctors remain skeptical of telemedicine practices, because they are unable to look at the patient and see the symptoms for themselves. Telemedicine puts more of the work on the patient; the doctor is not there to check everything as they would during a normal visit. Rather, the doctor receives the data from the patient to make a diagnosis.

How to Access Telemedicine Services

As the buzz around telemedicine spreads, so do efforts to improve telemedicine’s value, specifically through technological advancements. Telemedicine services are available in a range of forms. Patients can video chat, engage in audio conferences, or even use a smartphone app. Several companies, such as Tyto and the MedWand, are in the process of creating home diagnostic devices which allow patients to easily and correctly collect important diagnostic information and relay it to their care provider via telemedicine. Once these products have been approved by the FDA and become available on the market, patients will be able to utilize telemedicine more completely.

Insurance Coverage for Telemedicine

 Insurance coverage for telemedicine has also been a key factor in its growth. Telemedicine services are covered by both Medicare and Medicaid, and are being covered by a growing number of insurance providers.

Unfortunately, reimbursement for telemedicine is also dependent on individual state policies, which has greatly slowed the acceptance of telemedicine. States decide the terms and to what extent telemedicine services are covered. The state can choose every detail, down to what type of telemedicine to cover, where in the state it is covered, or how much to reimburse.

31 states have embraced telemedicine. A few states, such as Arkansas and Texas, have not accepted telemedicine coverage at all.  For a state that prides itself on its institutions of medical advancement and its expansive healthcare coverage for citizens, Massachusetts surprisingly lags behind other northern states in its acceptance of telemedicine policies. Massachusetts legislators have had to work with insurers to make changes to a telemedicine bill that was recently introduced in the State House of Representatives to provide coverage for Massachusetts residents. The bill, once passed, would finalize reimbursement rates and solidify the telemedicine guidelines within the Commonwealth as well as ensure that telemedicine practices align with national healthcare standards.

The last action on House Bill H.4442: An Act advancing and expanding access to telemedicine services was conducted on July 28th, 2016.  The Committee on House Steering, Policy and Scheduling decided that the matter will “be placed in the Orders of the Day for the next sitting for a second reading”.  No information has been presented on the Commonwealth website or reported in the news since that. Opposition to the telemedicine bill by certain legislators and insurers is apparent and the reason is largely reimbursement parity.

The Commonwealth received an “F” from the American Telemedicine Association for its poor implementation into insurance plans. The standardization of coverage for telemedicine services by big insurance companies, along with the bill revision, should sustain support for telemedicine services in the state. In Massachusetts’ defense, the implementation process of a service as innovative, and seemingly controversial, as telemedicine can take immense amounts of time and tedious work.

Two insurance companies are currently offering telemedicine reimbursement in Massachusetts.  Blue Cross Blue Shield Massachusetts has been offering telehealth benefits to fully insured accounts since January 2016. Tufts Health Plan also implemented telemedicine services that follow the New Hampshire Telemedicine Act until Massachusetts passes one of its own.

Compliance Issues for Employers Offering Telemedicine Coverage

Employers who want to offer telemedicine health coverage must expend time and energy to add telemedicine to employee health plans. If companies and municipalities are considering the sponsorship of telemedicine for employees, here is a quick run through on common compliance issues that you may run into with telemedicine programs:

  • ERISA – If an employer offers telemedicine, it must be offered as part of a group health plan in order to be considered an ERISA.
  • ACA – Compliance with the ACA is only an issue if it is not bundled with the employer’s group health plan. Non-bundled telemedicine programs require meeting the market reforms of the ACA, with excise tax payments due if compliance is not upheld.
  • COBRA – COBRA has no specific telemedicine policy, but telemedicine programs offering “visits” with licensed workers able to give patients prescriptions can be covered by a group health plan or a stand-alone health plan.
  • HIPAA – In group health plans, HIPAA may cover some of the telemedicine program offered to employees. A group health plan that is self-insured may not be covered by HIPAA. Most telemedicine practices are also already covered by health care providers that include HIPAA.

The Future of Telemedicine

Telemedicine is on the brink of becoming the innovative driving force of the medical world. Despite its small impact on the primary care industry now, the signs for telemedicine’s universal debut are evident. When a novelty such as telemedicine is being introduced into state legislation and has products being launched into the marketplace that expand on its services, both its value and its relevance are clear.

As demand for telemedicine continues to grow and more than half of the states have introduced laws on telemedicine, employers would do well to stand out as one of the first to offer telemedicine in their employee health plans. Employees entering the workforce will certainly come to expect a service like telemedicine that is in real-time and instantly gratifying. As telemedicine gains momentum, today’s families and professionals will likely come to prefer a virtual trip to the doctor.

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