Telehealth and its emergence as a critical healthcare component is becoming painfully evident. Patient demand is rising and according to Zion Market Research, an estimated $38 billion will have been invested by the year 2022 by companies such as Google, IBM, Samsung, and many more. Right now, the only billable facility charge is the originating site facility fee. The originating site is the location of the patient at the time of service. This is represented by HCPCS code Q3014. As you can see below, that code has been billed increasingly, on a national level, over the past few years.

The graphs below show the same statistic but on a state level. Indiana alone went from 51 facility claims in 2012 to 2,239 in 2016.

Clarification

Before we go too far, here is where we should explain that Telehealth and Telemedicine, while often used interchangeably, are distinct from one another. Telehealth is the general term referring to the diverse assortment of technologies used to provide patient care, education, public health, and administrative services remotely. Telemedicine, however, is a subset of Telehealth referring solely to the administration of clinical services and education at a distance. Therefore, all Telemedicine is Telehealth but not all Telehealth is Telemedicine. Both share the responsibility of increasing access to treatment and improving the effectiveness of healthcare delivery.

Future

Telehealth and, inherently, Telemedicine are quickly becoming the hot topic of conversation around the business office water cooler. According to a 2016 REACH survey, a Telemedicine software company, nearly two-thirds of the providers tested listed Telemedicine as a top or high strategic priority. This was a 10% increase from 2015.

The market for Telehealth is one of the fastest-growing sectors in healthcare and is expected to continue its rapid expansion especially now that CMS is putting a great deal of pressure on providers to improve the efficiency of care delivery while reducing costs. Telehealth services have the ability to solve three of our most challenging problems with dispensing quality services to patients – access to care, cost of effective delivery, and distribution of limited providers.

Quality

A doctor by the name of Rahul Sharma, the emergency physician-in-chief at New York-Presbyterian, said the number one complaint of patients in the emergency room is wait times. Dr. Sharma’s ER implemented a Telehealth program and cut the average time spent in the emergency department by more than half. A number that came out to be around 35 to 40 minutes. Dr. Sharma said, “ten years from now, tele-emergency medicine will be the standard around the country.”

With the incredible advances in technology over the past two decades, it is no wonder that patients have become less hesitant to receive services via an interactive audio and video telecommunications system. In fact, according to a Harris Poll survey, 64% of patients are willing to participate in a video visit with a doctor and of those, 61% said convenience was a factor. Not only is it convenient for a patient and a provider, it is also drastically more cost-effective. Researchers at the Alliance for Connected Care conducted a study and found, on average, a Telehealth visit costs between $40 – $50 compared to an average estimated cost of $136 – $176 for an in-office visit. That is an average savings of $126 per visit, to the patient. They also found that 83% of health conditions were addressed and resolved after a Telehealth visit.

In addition, we all know or at least common sense would tell us, that patients who are diagnosed and treated earlier often have improved outcomes and less costly treatments. According to the California Telehealth Resource Center, providers with Telehealth supported ICUs have substantially reduced mortality rates, reduced complications, and reduced hospital stays. Currently, the national average for re-admission to hospitals within 30 days following a heart failure episode is 20%. Telehealth monitoring programs have reduced that level to less than four percent.

What’s New

For CY 2018, CMS is finalizing the addition of several codes to the list of Telehealth services, including:

• • HCPCS G0296 (visit to determine low dose computed tomography eligibility),
• • CPT 96160 and 96161 (Health Risk Assessment),
• • HCPCS G0506 (Care Planning for Chronic Care Management), and
• • CPT 90839 and 90840 (Psychotherapy for Crisis).

CMS is also deciding on separate payments for CPT code 99091, which describes certain remote patient monitoring, for CY 2018. Finally, CMS is also considering input received in response to the proposed rule’s comment solicitation on how CMS could expand access to Telehealth services.

If you have any questions or would like to discuss Telehealth services, program implementation, or billing and reimbursement please contact your local Blue & Co. advisor.

REFERENCES
2017 U.S. Telemedicine Industry Benchmark Survey – REACH Health (https://www.healthlawinformer.com/wp-content/uploads/2017/05/2017-telemed-us-industry-survey.pdf)

The Under-an-Hour Emergency Room Visit – Health Matters: New York Presbyterian (https://healthmatters.nyp.org/emergency-room-express/)

Proposed Policy, Payment, and Quality Provisions Changes to the Medicare PFS for Calendar Year 2018 – CMS.gov (https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2017-Fact-Sheet-items/2017-07-13-2.html)

Why are Telemedicine and Telehealth so Important in Our Healthcare System? – California Telehealth Resource Center (http://www.caltrc.org/telehealth/why-are-telemedicine-and-telehealth-so-important-in-our-healthcare-system/)

The Telehealth Market is Booming but Reluctance Remains – Chiron Health (https://chironhealth.com/blog/telehealth-market-is-booming-but-reluctance-remains/)

Assessment of the Feasibility and Cost of Replacing In-Person Care with Acute Care Telehealth Services – Dale H. Yamamoto – Alliance for Connected Care (http://www.connectwithcare.org/wp-content/uploads/2014/12/Medicare-Acute-Care-Telehealth-Feasibility.pdf)