CMS recently issued a mandated report to Congress entitled Information on Medicare Telehealth that in part, provides information on the utilization of telehealth services and discusses barriers to expand its use in Medicare. CMS notes that telehealth use has increased, is rather beneficial for patients with behavioral health and/or chronic conditions and has the potential to “improve access to care, reduce costs, and enhance patient satisfaction.” But, and unfortunately with telehealth, there always seems to be some sort of ‘but’; our good ol’ government is impeding use, which is why adoption remains relatively low.

Shocking, right? No. Not in the slightest.

Although necessary, regulations and statutes can really bog things down sometimes.

Before I get on my soapbox, here are some of the findings from the report:

• The number of fee-for-service (FFS) Medicare beneficiaries receiving telehealth services increased by 48.3 percent between 2014 and 2016
• The number of telehealth services provided to FFS beneficiaries increased 65.3 percent between 2014 and 2016
• States with the highest use of telehealth among FFS beneficiaries have large rural areas which are typically health professional shortage areas (HPSAs)
  • State with highest percentage of utilization was Texas at 11.8 percent
• Patient and provider acceptance of telehealth and related technology as a means of health care delivery has substantially increased
• Primary use of telehealth among FFS population is for standard office visits followed by individual psychotherapy
  • Individual psychotherapy telehealth services saw a 170.2 percent increase between 2014 and 2016
• Medicare payment policies greatly limit the geographic and practice settings in which beneficiaries can receive care for providers to be reimbursed
  • Originating site restrictions are greatest barrier to expanding use
    • Generally, must be in rural area and can’t be in beneficiary’s home
  • Reimbursement for store-and-forward technology is only provided for services in Alaska, Hawaii, and as part of a federal telemedicine demonstration program

Despite some of the statutory barriers around telehealth in Medicare FFS, its use in Medicare Advantage continues to increase. A recently proposed rule will waive some geographic restrictions for Medicare Advantage plans by 2020 thereby increasing access to beneficiaries in urban locations.  

Another Medicaid managed care proposed rule will enable states to take telehealth into account when determining network adequacy. This is remarkable because it’s the “strongest stance CMS has taken on the potential of telehealth as it relates to ensuring adequate access to contracted health services for consumers” as I note in my recent blog on The URAC Report.