Telehealth Reimbursement Remains Low Despite Interest

In spite of a surge in telehealth-related policies, telehealth claims numbers remain low, according to an analysis of private payer reimbursements to primary care providers (PCPs) for telehealth services from 2009 to 2013.

Telehealth services—which include live video delivery, use of store and forward services, and remote patient monitoring—are expected to expand the service delivery for PCPs and decrease economic barriers to care. These services also maintain an equivalent or improved quality of care as traditional in-service delivery care sites.

As such, there is an increasing interest in the expansion of these services and states are developing methods of facilitating telehealth-related reimbursements. Yet only 7 states have passed statutes mandating parity with reimbursement for non-telehealth services and claims to private insurers for these services remain low.

A team of researchers led by Fernando A. Wilson, PhD, categorized state policies involving telehealth in clinical care and reimbursement, and analyzed a private claims database to document trends in telehealth-related billings by PCPs, comparing reimbursements for clinical procedures using telehealth claims with non-telehealth claims.

The team used claims data from the Health Care Cost Institute from 2009-2013. PCP specialties varied, and reimbursements and charges were adjusted for inflation up to 2015.

The researchers discovered that 21 states require coverage for live video transmission, 4 states require coverage for store and forward policies, and 4 states require coverage for remote patient monitoring. Mississippi was the only state to require some coverage for all 3 of these technologies. Many state Medicaid programs take into account telehealth services, but their policies vary from location to location.

During the 2009-2013 period, there were 6506 telehealth claims and 95.9 million non-telehealth claims. Although there was an initial increase in average reimbursements for telehealth claims from $60 to $68, rates decreased again in 2013 from $68 to $38. Non-telehealth reimbursement increased every year, rising from $57 to $61.

Survey results also suggested that 1 in 8 PCPs use internet or e-mail for some patient consultations per week. Rates of Medicaid versus non-Medicaid providers who used internet or email were nearly identical. However, Medicaid PCPs who receive less than half of their revenues from Medicaid used internet or e-mail more often than Medicaid PCPs who received most of their revenues from Medicaid. There have been no indications of why this might be the case.

In spite of multiple states mandating that payers cover telehealth services equivalent to non-telehealth services, telehealth claims remain low. The researchers speculate that this could be because providers are not up-to-date with changing state policies or that there could be some confusion over which billing codes to use for telehealth claims.

Overall, it would seem that that more data is required to evaluate whether or not telehealth policies are having their intended benefits, and to determine how many providers and to what extent providers have taken advantage of telehealth technologies.