With the growth of connectivity and smart device support, telemedicine and telehealth services are becoming an increasingly popular tool for doctors in all fields of healthcare. For patients, telehealth may offer convenient care that is accessible while still staying comprehensive and personal. The most common question with telemedicine is its cost. Read on to learn more about the costs and reimbursements involved with this emerging technology
What is Telemedicine?
Telemedicine refers to providing patients with care, including diagnosis, treatment, and consultation, through any telecommunications technology. While that initially meant phone calls, telehealth today most often comprises video conferencing via smartphone, computer, or tablet. This is known as real-time or synchronous telemedicine, and it allows a patient to receive just about the same level and type of care as an in-person appointment. Alternate forms of synchronous telemedicine can also take place in a physician’s office, where a patient can speak with a physician via webcam while an assistant (sometimes known as a telepresenter) can provide hands-on care, like performing a physical exam or recording the patient’s blood pressure.1
The other type is store-and-forward or asynchronous telemedicine. Unlike synchronous telemedicine, which involves real-time audiovisual interaction, store-and-forward is more akin to sending and receiving emails. The patient can send text, videos, photos, and other information to the doctor, and the doctor can reply when they have the opportunity, and vice versa. This is more convenient for patients or clinicians who may have a busy schedule or are otherwise unable to schedule real-time sessions. Asynchronous telemedicine is commonly used in radiology, dermatology, and pathology.1
Telemedicine can also include remote monitoring. Also known as self-testing or self-monitoring, remote monitoring allows a patient to send health and clinical signs and data to a doctor via their own monitoring devices. This is most common among patients with diabetes, who can use continuous glucose monitors to track blood sugar levels throughout the day while relaying the data to a doctor. Remote monitoring may also be used for other conditions, including asthma and heart disease. While remote monitoring does run the potential risk of inaccurate testing, most results are considered to be on par with professional tests done in a clinic.2
While telehealth can take different forms, in practice it can involve all three of the above. A patient may schedule a real-time appointment to receive a diagnosis or treatment plan. This may be followed up with store-and-forward consultations to determine how a patient is doing. Furthermore, telemedicine can be used in conjunction with in-person appointments to provide more comprehensive care.
The Cost of Telemedicine
An initial study from 2014 found that the average estimated cost for a telehealth visit was about $40 to $50, while in-person acute care visits were estimated to be about $136 to $176.3 The average number of telehealth visits is about 1.3 per year, and about 83 percent of the time, the patient’s issues can be resolved with just one telehealth visit, most often involving cases of sinusitis, cold and flu, and urinary tract infections.3 However, the exact costs for a patient will vary based on several factors, including the service provided, the condition that is being addressed, and health insurance.
This also doesn’t take into account the potential savings involved to both patients and doctors. Patients, particularly those in small, rural, and underserved communities, do not have to spend money to travel to a specialist. They also do not have to take time off from work in order to visit the doctor. Similarly, doctors do not have to worry about travel expenses to visit more remote communities, while subspecialists who often have to travel to multiple sites can see patients in the comfort of home.
Reimbursement can be tricky as there is still no set standard for health insurance providers and telemedicine. While telemedicine is gaining traction among healthcare providers, many insurance companies still have trouble seeing value in it, which may mean you would require prior approval for telemedicine before you receive reimbursement. Private payers may still cover telemedicine, though they may not be legally required to provide reimbursement.
Thankfully, some states do have parity laws. Coverage parity means that both telemedicine and in-person services are covered based on the same indication. Payment parity means that reimbursement for telemedicine is the same rate as in-person service.4 According to the American Telemedicine Association, 29 states and the District of Columbia have some sort of telemedicine parity laws that require private payers to reimburse the same amounts for telehealth and in-person services. Only 11 states in the country do not currently have parity laws for telemedicine covered by private insurance. Other states have a partial parity law or have proposed bills to enforce parity.5
Telemedicine and Medicare
Things are about as complex under Medicare. Original Medicare is split into two parts. Part A covers inpatient care, while part B covers outpatient care. This is all under the Fee-For-Service program. Although telemedicine is included under part B, you would only be covered for a telemedicine appointment if it is medically necessary and if the Medicare doctor follows the guidelines for arranging and executing the consultation. The doctor must conduct the consultation in real-time with both an audio and video feed. The patient must live in a designated rural area, while video conference must be held at a designated originating site, which includes a physician’s office or rural health clinic.6
Medicare will generally pay for a telemedicine consultation, including facility fees and provider fees to the facility or doctor at the originating site.6 Again, this only covers real-time sessions and only certain populations (rural communities, Health Professional Shortage Areas, and counties outside metropolitan statistical area).
Telemedicine and Medicaid
Currently, 48 states and the District of Columbia have some sort of policy in place that allows Medicaid to cover telemedicine services. This includes some type of reimbursement for telehealth.7 Telehealth and telemedicine services covered by Medicaid in these states include:
- Real-time communication
- Remote monitoring
- Mobile health (mhealth)7
Ultimately, reimbursement for telemedicine services can vary greatly based on the insurance company and the state policies. It’s worth it to look up local policies to understand if telemedicine is covered and if you will receive reimbursement for telemedicine. Many patients will choose to pay out of pocket based on the lower cost of a telemedicine visit, on top of the general convenience and the urgency of the visit.
The larger potential savings that could come with a shift to telemedicine still require further studies, though taking into account the savings involved with travel and convenience, telemedicine could change the structure of healthcare costs.
The exact costs to patients and practices will vary, but $40 to $50 for a general telemedicine appointment is a good place to start. If you are considering incorporating telemedicine into your existing practice, do your research on reimbursement policies in your state, particularly those involved Medicaid, and train your billing staff on your findings. If this seems like too much trouble, you may consider charging convenience fees.
For providers looking into this type of technology, check to see if your health insurance covers telemedicine services and shop carefully to find a telehealth platform that has trusted specialists while still fitting your specific needs and budget.