The next two years will see substantial growth in telehealth reimbursement and clinical setting expansion based in part by acts of Congress and CMS implementation.
One key to growth within both counts is the continued elimination of historical originating site restrictions on where telehealth can occur. CMS has long been tied to originating site federal rules dating back to the Social Security Act, meaning reimbursable telehealth could only occur in federally designated rural zones, aka rural health shortage areas, and be conducted by “distant site practitioners.”
These limitations are increasingly going away.
In the meantime, telehealth has still grown. According to MedPAC, telehealth visits per beneficiary from 2014 to 2016 rose 79 percent, resulting in $27 million in spending, and by that comparing claims from 2015 to 2016, the number increased by 33 percent, totaling out at just below 500,000.
Not huge numbers, but growth. There is arguably no greater summation of the state and future of telehealth than MedPAC’s March, 2018 report to Congress on telehealth, which can be accessed in full here.
The report, mandated by the 21st Century Cures Act, also notes that commercial payment models need to catch up, describing a landscape of “few plans” offering “variable” levels of comprehensive payments as of 2017 that could be counted as quality or value-based care programs.
At the state level, 35 states and Washington, D.C. do have telehealth parity laws, requiring insurers to cover payments for telehealth occurrences equal to an in-person visit.
Growth within private payers should be impacted by upcoming government-led expansions impacting ACOs, Medicare Advantage and the physician fee schedule, where originating site restrictions won’t apply based on new federal law.