Telemedicine at crossroads as CMS mulls final rule

This year SearchHealthIT will be attending the American Telemedicine Association’s annual meeting in Tampa. One of the reasons we’re looking forward to it is because of the story: Telemedicine technology is on the brink of a rapid expansion as the Centers for Medicare & Medicaid Services (CMS) and The Joint Commission get on the same page to credential telemedicine’s providers and standardize its reimbursement. Nothing official has been announced, but CMS could prepare to reimburse health care providers for telemedicine services with a credentialing document that could drop as soon as this month.

As CMS goes, so go private payers; if CMS ratifies its own system to reimburse telemedicine services, it would elevate telemedicine from gee-whiz trade show demos (and pithy Cisco Systems television commercials) to an actual profit center for hospitals and ambulatory providers. Specialists — consulting both patients and other physicians — could stand to gain the most, although the same could be said for the patients living in remote areas who don’t currently have access to the specialists they need.

Several providers, however, didn’t hang around and wait for CMS; they hooked up with American Well Inc. to provide online house calls. The company’s modus operandi is to team up with insurers to connect physicians with patients on a state-by-state basis by phone, Web, and video. Hawaii Medical Services Association, a Blue Cross Blue Shield payer, reimburses patients for these American Well appointments. Two other BCBS payers, in Minnesota and western New York, don’t reimburse patients yet for what American Well calls “online house calls,” but recommend the service to their customers as a convenience (it varies, but for example a 10-minute video or phone consultation in New York runs $25).

What kind of patients are taking advantage of this telemedicine service, which documents each visit and delivers a continuation of care document (CCD) to the patient’s primary care physician, complete with health care-specific information, such as billing codes?

Typically, said Dr. David Ellis, a Buffalo, N.Y., emergency room physician in the American Well network, patients aren’t presenting with grave or chronic illnesses, but rather with acute, infectious, “straightforward problems” that don’t necessarily present with big degradations in vital signs: bronchitis, sinusitis and the like, conditions he can address.

“People do self-select,” Ellis said. “Many times, they’re bringing up problems that they’ve had episodically before, so they’re somewhat familiar with their symptoms and the problems that they have — and so the patients are identifying [American Well] as a better way to get this problem solved in a timely fashion so that [they don't] miss work or any other obligations.”

Ellis, a telemedicine veteran who has been using the technology since the mid-1990s — including video over the Web to treat patients in state prisons — mostly has done telephone sessions in conjunction with a Web meeting. He believes that as webcams and cell phone video cameras continue to proliferate, the more likely it is that live video will be involved in telemedicine sessions. He sees a lot of potential for such conditions as congestive heart failure to be managed with telemedicine services like American Well more closely than with intermittent office visits, as they typically are managed now.

That is, once CMS, health care providers, and The Joint Commission get their acts together to figure out a fair way of compensating physicians for their time, capturing the right data and delivering the CCD to the patient’s electronic health record.

 ”It’s always a negotiation between patient, provider and insurer,” Ellis said. “I think what American Well has been able to do is find that sweet spot of the amount of time involved, the type of interaction and having the appropriate technology available to accomplish those goals.”