Making the case for virtual care reimbursement

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October was a busy month with two conferences, one specific to Telemedicine and the other general for all emergency physicians. Much of it demonstrated telehealth’s growth although with some of the same unresolved discussions. Some of the highlights for me this month included:

ACEP Conference

  • The American College of Emergency Physicians Telemedicine working group changed the name of its group from Telemedicine to Telehealth. The reasoning was that telehealth is considered broader, embraces both acute care and chronic use of telehealth and therefore was adopted.
  • The group also welcomed their new chair and made a point of creating working groups aimed at specific issues in EM Telehealth including:
    • Operational Guidelines
    • Disaster: use of TH in natural and other disasters
    • Research: in evaluation of outcomes and safety
    • Practice Guidelines: for potential validation of TH practice

SEARCH Conference

  • Research has been a large focus and attending the SEARCH – Society for Education and the Advancement of Research in Connected Health – Conference continued the discussions. This particular conference is specific on telehealth, but is not specific to medical specialty. It included discussion on quality outcomes, policy, measuring value and how and where to publish research so can disseminate information. Much of the studies continue to be retrospective, but a few have begun to encompass prospective trials; a necessary step for improving telehealth research.

CMS proposal

  • Discussion continues on the CMS’s proposal for virtual care reimbursement where Medicare would pay $14 per virtual check in – an audio or video connection with a patient’s physician to determine if an in-person visit is necessary. The check-ins can be conducted by APPs also. Medpac has come out against this proposal due to their concern that it can increase costs without  improving quality as the check-ins are not sufficiently different than a direct to consumer service where patients also initiate the visit.  Physicians also are concerned due to costs to patient. CMS states that the proposal shoulder overall create cost savings in the form of fewer office visits and earlier intervention for chronic and acute disease.

Overall, discussions in healthcare continue to become more specific on improving quality and use cases. Policy and payment discussions are a welcome change despite the disagreements on the best path forward.

ABOUT THE AUTHOR

Dr. Aditi Joshi is an Emergency Medicine Physician who has worked in Telemedicine for over five years, beginning at a startup and moving onto an academic institution. She is the current Medical Director of JeffConnect, part of Thomas Jefferson University Hospital's Telehealth program. She is particularly interested in the issues of patient access and engagement, provider education and fostering international collaboration.

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