As you all know, the subject of telehealth reimbursement continues to vex the community. For example, Medicare lags far behind. According to the Center for Telehealth and eHealth Law, Medicare reimbursed approximately $14 million total under its telehealth benefit for 2014. This represents less than .0025 percent of the total Medicare reimbursed for services that year. Medicaid is something of a mixed bag with the vast majority of states providing some coverage for telehealth, but many lagging in coverage and reimbursement for store-and-forward services and remote patient monitoring. Generally speaking, private payers have been ahead of the curve with the majority of states having parity laws in place requiring insurers to cover telehealth services in many circumstances.
One of the issues about which I am often asked is whether there is any data surrounding private pay reimbursement for telehealth. A paper published by the Health Care Cost Institute provides some interesting data into telehealth billings. The good news is that telehealth has extensive room in which to grow. Among other issues, the paper analyzed one of the largest private claims databases to analyze trends in telehealth billings from 2009-2013. Here are some key takeaways:
- There were 6,506 claims for services related to telehealth submitted by primary care providers (compared to the 95.9 million non-telehealth claims).
- Family practice providers submitted the most claims for telehealth followed by internal medicine.
- Non-telehealth service reimbursements increased every year since 2009, from $57 to $61.
- Average reimbursements for telehealth claims, however, declined substantially after 2011, decreasing from $68 to $38 in 2013—40% lower than that for non-telehealth claims in 2013.
- California and New York had relatively small numbers of claims when analyzed against their large populations.
- Among seven unique CPT codes for an office/outpatient visit for evaluation or management of a patient, average telehealth reimbursements were nearly the same or lower than the non-telehealth service for six of these procedures.
- The most commonly diagnosed problem seen by primary care providers using telehealth (in descending order) were diabetes mellitus (almost 14% of all telehealth claims); depressive disorders; acute sinusitis; biopsy of the lymphatic structure; obstructive sleep apnea; bipolar disorder; and acute upper respiratory infections.
The paper notes that despite the increased use of telehealth, claims for telehealth services to private insurers are rare which the paper acknowledges could be due to the “considerable time lag in the translation of [state telehealth policies] into provider behaviors. There is also some discussion suggesting that low telehealth billings may be due to confusion regarding the appropriate billing codes to use.
My sense is that a lot has changed since 2013, and that should a review be done today, telehealth billings would have significantly increased. Nevertheless, the paper clearly confirms telehealth has plenty of room in which to grow.