The percentage of beneficiaries of federal health care programs using telehealth technologies ranges from under 1% per year for Medicare and the Department of Defense (DOD) – to 12% in the Veterans Administration (VA). For Medicaid, the states set parameters on reimbursement and coverage, so utilization is highly variable by state. These data were in a new report from the U.S. Government Accountability Office (GAO), Telehealth and Remote Patient Monitoring Use in Medicare and Selected Federal Programs – and it shows that for all the “potential” of telehealth, the utilization numbers are low.
In fiscal year 2015, 25,389 DOD beneficiaries used telehealth – about 0.3% of consumers. Not surprisingly, behavioral health/psychiatric services comprised about 80% of these encounters. The VA has great use of telehealth. The VA provided 702,000 veterans with telehealth services in FY 2016, about 12% of veterans receiving services. Of these, 45% were in rural areas and 150,600 of these consumers used remote monitoring services, most commonly for diabetes and hypertension.
The big issue is Medicare. Of the 55 million Medicare beneficiaries in 2014, only 68,000 or 0.68% used some type of telehealth service. These consumers average three visits per year, for an average of $182 per consumer. Surprisingly, 62% of the Medicare beneficiaries using telehealth are under the age of 65. And, 66% of telehealth services were for evaluation and management, followed by 19% for psychiatric visits. Behavioral health clinicians, including psychiatrists, made up 62% of the clinical professionals making telehealth visits. There are no separate Medicare numbers for remote monitoring services, since they are bundled in with other services. For example, in 2014 Medicare spent $199 million on 639,000 beneficiaries receiving remote cardiac monitoring.
While the GAO report pointed out the very low utilization of telehealth services in federal health care programs, the report was quick to point out all the potential benefits of telehealth – from improving quality of care to consumer convenience to addressing specialist shortages. But with all the benefits, why is utilization so low? A survey of provider associations and patient associations identified, for Medicare, low reimbursement rates and confusing coverage requirements in terms of geography and practice settings as primary reasons for low utilization. Patient and provider training, the “culture” of care, and state licensure issues also made the list.
So what does the future hold? I think the use of telehealth will increase if we see the continued expansion of Medicare value-based reimbursement programs (see Alternate Payment Models – Strategy Implications Of The CMS Roadmap) and if Medicare Advantage plans (now 30+% of beneficiaries) are successful in getting Medicare to allow them to use telehealth services (I know, it’s surprising that is not the case.) Currently, there are several Medicare programs that waive the general telehealth requirements:
- Next Generation ACOs are exempt from the geographic and practice setting limitations on telehealth in the Medicare plan. In fact, of the 18 Next Generations ACOs operating in 2016, 15 provided CMS with detailed plans to expand telehealth use via telehealth waivers (see How Is The Medicare ACO Performance Payment System Structured?: An OPEN MINDS Market Intelligence Report and Specialty Provider Organization Opportunities For Working With ACOs.)
- Medicare’s bundled payment program is also exempt from those geographic and practice setting limitations (see Are Bundled Payments Working? An Evaluation Of The Medicare Bundled Payments For Care Improvement (BPCI) Initiative and The Era Of Value-Based Reimbursement – When Doing More Is Not Enough).
- In addition, according to the GAO report, the three upcoming Medicare episode payment models will also liberalize the rules for use of telehealth (see Alternative Payment Model Design Toolkit and Transitioning To Episode-Based Payment).
In addition, the new Medicare Merit-based Incentive Payment System allows use of telehealth to coordinate care for some rural consumers and for remote monitoring – and that utilization qualifies for incentive payments. However, provider organizations are not permitted to bill the services outside of the existing geographic and practice setting limitations.
I realize change is slow – particularly in this area of health care. But it seems this is an area where consumer preference (for telehealth) and the potential system improvements from telehealth are far ahead of the reality on the ground. Want to learn more about the state of telehealth? Check out these resources:
- The Telehealth Market – Now, Soon & Future
- Competitive Advantage Via Telehealth
- A ‘Perfect Storm’ For Telemental Health
- What Technologies Will Change Service Delivery For Consumers With Complex Needs?
- How Do Medicare & Medicaid Reimburse Telehealth Services?: An OPEN MINDS Market Intelligence Report‘
- Looking For Evidence That Telehealth Is The Future? The Mayo Clinic Is Funding Tele-ICU System Costs For Medicare Beneficiaries
- Technology Innovation In Health & Human Services – The Future Is Now
And, be sure to attend the “Telehealth Best Practices: How To Build A Successful, Sustainable Program” session on November 7 at The 2017 OPEN MINDS Technology & Informatics Institute, taking place in Philadelphia, Pennsylvania.