Advocates of telemedicine are heralding a $150 million agreement by the Clinton administration and the recently ended 106th Congress to widen access to service and raise physician reimbursement levels for Medicare patients beginning this fall.
The funding, which was appropriated for a five-year period, is seen as a major boost for rural healthcare.
A provision in the Medicare-Medicaid funding bill signed last month expands the Medicare telehealth program to all counties outside metropolitan statistical areas and, for the first time, allows reimbursement for telemedicine at urban Medicare demonstration sites. Previously, the program was restricted to designated rural areas with a shortage of healthcare providers.
It also broadens the scope of covered services, ends fee-splitting among local and referring providers, and removes several other restrictions on physicians.
"This is a real breakthrough for healthcare in rural areas," says Rep. John Thune (R-S.D.), who championed the legislation in the House. "The telehealth provisions included in this bill will vastly improve the access and quality of healthcare in rural America."
Currently, Medicare recipients in rural counties not designated as underserved often must travel great distances to see specialists if they expect the federal insurance program to pick up the tab. "This is a quality-of-life issue," Thune says.
Jonathan Linkous, executive director of the Washington-based American Telemedicine Association, says that Congress effectively told HCFA that the agency was not doing enough regarding healthcare access in underserved areas.
"HCFA has not been real supportive of telemedicine," Linkous says. "This sends a very symbolic message not only for (the incoming Bush administration) but also for insurance companies that there's a real recognition of telemedicine."
Linkous says he believes that the legislative action will prompt private
insurers to consider improving their own benefits for remote consultation. The ATA, established in 1993, advocates greater access to telecommunications-delivered healthcare. Its membership includes individual healthcare professionals and organizations.
The new rules take effect Oct. 1, the beginning of the federal government's 2002 fiscal year. HCFA was instructed by the legislation to issue specific guidelines for program participation before October, though an agency source indicated that the regulations might not be finalized until the end of the year.
A document issued by Thune's office last summer states that Medicare covered just 6% of all telehealth services for elderly and disabled patients in 1999.
According to Linkous, the figures show there is a "dramatic need" for expansion of coverage.
"Telemedicine can provide services (to rural residents) at a lot lower cost for Medicare and at a lot lower cost for patients," Linkous says.
The changes broaden the Medicare telemedicine program beyond mere consultation with remote specialists to include coverage for office visits, drug maintenance, psychotherapy, and other services defined by dozens of specific CPT codes. The legislation authorizes HHS to modify the list of allowable procedures annually.
The new rules also eliminate what Linkous calls "some real arcane restrictions." Medicare will not require a "telepresenter"--a physician or other qualified healthcare practitioner--to be present at the rural site with each patient during a consultation with the remote specialist.
Also abolished is a controversial HCFA policy of splitting Medicare reimbursements for telehealth 75% for the remote consultant and 25% for the referring physician, which discouraged specialists from offering such services.
Instead, the consultant will get a full Medicare payment, while the originating site will receive a flat $20 facility payment.
The facility fee will be indexed for inflation beginning in January 2003.
Additionally, because of time differences between Alaska and Hawaii and the rest of the country, the legislation provides coverage for "store-and-forward" asynchronous consultations, or those services provided with an electronic delay, to a limited number of patients in those two states.
