Does telehealth pay?

January 22, 2020

CMS has been slowly pushing telehealth, making it an option for Medicare Advantage plans and ACOs, as long as they are part of risk-sharing contracts. It’s also allowed under Medicare Part B for treating substance abuse disorders.

Doctors looking to increase reimbursement might want to  consider telehealth. CMS has been slowly pushing telehealth, making it an option for Medicare Advantage plans and ACOs, as long as they are part of risk-sharing contracts. It’s also allowed under Medicare Part B for treating substance abuse disorders.

States have also done more to promote telehealth through parity laws. “This requires private payers to pay telehealth equal to an in-office visit,” says Cindy Gaines, MSN, RN, clinical leader, Philips Population Health Management. “Forty states have passed laws to make it more equitable to providers and patients.”

Telehealth reimbursement is currently a disjointed system where doctors often struggle to understand who is covered. “CMS is covering pockets of patients, some states are covering private payers, Medicaid isn’t covered yet-it’s hard to jump into telehealth, because it’s hard to know which patients are included,” says Gaines, adding that she expects these issues to be solved in the coming years. In addition, patients will start to expect it as an option, something small practices need to pay attention to.

“Small practices have to look for ways to extend their sightlines to manage a population with limited resources,” says Gaines. “They may be able to partner with another small group to do the services together. They don’t have to be part of a bigger system, but may need to develop relationships to facilitate telehealth.”

Most importantly, Gaines says, practices need to think about how telehealth can help them improve care for their patients. “It’s more than just managing the care for those who come through your doors anymore,” she adds. “You have to support patients living well with chronic diseases when they are not in the office. This isn’t about technology taking over care, but how it can augment care.”