A new survey that is part of a whitepaper by PWC suggests that most Americans are receptive to receiving on-line medical care. Perhaps fearing that access to providers will only get worse due to increasing demand from national healthcare reform, consumers say they would welcome the opportunity to receive some medical services by phone, e-mail, telemedicine, and remote monitoring. According to the survey, 50 percent of consumers said they'd be willing to seek healthcare through the Internet or other computer technology as a substitute for a face-to-face, non-emergency visit. Of those, an e-mail consultation was the preferred method of interaction (76 percent), followed by telehealth, question/answer fee-based consults and an online forum/chat room monitored by a doctor. Nearly three-quarters of consumers said they would use biometric electronic remote monitoring services to track their condition and vital signs.
So why hasn’t telehealth taken off in a big way? It takes two to tango and up until recently, a physician’s ability to get paid for doing any of the above has been significantly limited. But that is changing.
Here on HealthBlog I shared information about telehealth services that are now being offered by HMSA to residents of Hawaii. Working with Microsoft partner, American Well, and Microsoft HealthVault, residents of Hawaii are flocking to telehealth services and physicians there are getting paid for providing them. American Well has announced expansion of services that will soon include residents of Minnesota and eventual national distribution through a partnership with United Healthcare.
Getting private insurers on the telehealth bandwagon is one thing. But more than 60 percent of healthcare spending in America is by government agencies (Medicare, Medicaid, VA). Until recently, doctors providing telehealth services to Medicare recipients not only couldn’t bill for those services, but would be subject to severe penalties and fines if they tried to do so. Such services were considered by Medicare as part and parcel of services already provided in the office and no additional billing of any kind was allowed.
I recently received notification from a professional colleague that suggests Medicare is beginning to see the light. Dr. Thomas Gumprecht is an ENT doc practicing in the Seattle area. More than a decade ago, he began lobbing private insurers to remove contract language that forbids additional billing for cognitive professional services provided to patients by electronic means including the telephone. He actually got the insurers in our area to agree that it was OK to charge for these services so long as any patients receiving them had been notified well in advance, and in writing, that they would be charged.
Now it seems that the federal government may be giving a green light to docs who want a similar arrangement for patients receiving Medicare. According to Dr. Gumprecht, “CMS now permits direct billing of electronic services----and it is important to say ALL ELECTRONIC SERVICES---PHONE, FAX, EMAIL, VIDEO, TEXTING----because logically it is a professional medical service being rendered electronically and the exact mode should not be one or the other but a continuum between all of them. With this breakthrough, most other carriers will fall inline with the CMS approach, and at least permit direct billing of patients”.
Dr. Gumprecht asked me to help spread the word. He went on to say, “Too many busy doctors will hear the news of CMS permitting direct billing but will not know the nuts and bolts of adopting it, or they will not exert the minor effort it takes to reformat their patient intake sheets (on the disclosure you must say the patient is responsible for electronic bills), tell their receptionists and office nurses how to handle phone, fax, or email requests for service. Once you have a month or so getting patients to sign disclosure forms on their patient intake sheets, the practice can start billing patients directly for electronic services”.
Dr. Gumprecht and the American Academy of Otolaryngology, Head and Neck Surgery referred to this citation in Medicare regulations (see pages 2-4). So, it does appear that barriers are coming down on telehealth services and for the physicians who would like to provide such services. Finally, people will have ways to get health information and medical services from physicians besides making appointments and being seen in an office somewhere. And docs providing those services can be paid. It’s about time!
Bill Crounse, MD Senior Director, Worldwide Health Microsoft