I attended - I didn’t like the fact that there was no analysis - there hardly ever is in these things and I think I am going to change that. I’d even give you the codes to look for to get these. One can easily parse demographic data onto these, heck, even diagnosis and follow ups that may have occurred.
The hosts were also kind of surprised that the audience reacted with quite different opinions about telehealth being an overall cost reducer. The hosts were of the opinion that it was. I’ll put my thoughts down on why I think it doesn’t reduce costs. I’ll also put my thoughts on who I think it really benefits the most. Just have to do it later.
I don’t know a ton about telehealth, so I don’t have a strong opinion. To the extent that you can replace in-person visits with telehealth, AND if telehealth visits are reimbursed lower, there could be some savings. On the flip side, I assume that some telehealth visits result in a request to be seen in person, so you basically generate two E&M bills for what could have been one E&M visit.
So I’m curious to hear thoughts/opinions or see data. I work in value-based care so I have a horse in the race, though I’m not doing much on the clinical side these days.
I’ve done a few telehealth visits. As a patient it saves me the trouble/expense/time of having to drive to the clinic, wait in the waiting room, expose myself to germs, etc.
From a clinical practice point of view, perhaps, they can see more patients in a day, but I wouldn’t think that would increase by much since the doc & everyone probably still needs to do the same amount of pre & post visit (paper) work…perhaps, more.
It could broaden a physician’s practice in that they can now see patients from Podunk, MT even though they are physically located in Paris, IL, but as Mathman stated, if it leads to an in-person visit that’s somethin’ else.
For the most part, though, I have no idea what I’m talking about. I’m a Life actuary…and only an ASA at that, but this is an interesting topic.
If the presenters have a financial interest in telehealth, then of course they believe this to be a cost-reducer.
On one hand, there might be increased utilization for stuff that wouldn’t normally be utilized.
On the other hand, catching some condition early might result saving a life and maybe lowering cost. 'course, it could also raise costs, catching now something treatable versus catching later something that is no longer treatable might result in higher costs, though saving a life.
Gonna guess wash.
Getting offshore doctors to do it might lower costs, assuming they’re in-network.
Some additional things that make my head spin:
1.) Doctors physically touch me in the office. They look into my eyes, ears and put a big wood thingy on my tongue to make me gag. They tap around my tummy and rub around my neck. Then they tap my funny bones with a hammer. They cannot do these things via phone and I think these are important things to do each time you need a visit.
2.) Its tech - and it will be adopted. People need access to apps, a phone, good interweb connection, a camera on their computer. The webinar said about 25% of the population do not have this.
3.) Mental (tele)health is where there are huge opportunities - we just need the supply of butts in the seats to get this going. Access to Social Workers, Counselors, Phychs. I think this would also increase costs. But this is important enough to be worth it.
4.) Only 44% of AMA physicians agreed/strongly agreed that telehealth reduced costs. 67% of the SOA participants guess (iirc) it will. I was obviously part of the 33%
re: broadening practice, this is actually a sore spot for me. My daughter, as a “resident” of Missouri, attended college in Illinois. While in the state of Illinois she couldn’t telehealth visit her therapist, who was in Missouri. So while it is valid in theory, the reality of >50 different jurisdictions for medical supervision means it’s not as big a broadening as promised.
You know what…now that you mention it…I recall that my daughter had the same issue…living in MN as a college student…considered a TX resident by parents’ address…had trouble getting coverage for some “thing”…I don’t remember the specifics anymore…also this may or may not have been associated with telehealth.
Regardless of my faulty memory, your point of jurisdictional-barriers is a good one.
As part of the pandemic response, price parity was included for telehealth by CMS (Medicare/Medicaid), and the state where I live passed a law to have telehealth parity for all, including post pandemic. The place that we have seen savings is decreased non emergency medical transportation costs and ED visits (low/moderate severity), offset by decreases in missed appointments (and, yes, potentially secondary in-person visits that would have previously been a single visit). Access to behavioral health providers has been expanded by the availability of telehealth, which allows for increased utilization and thus costs. That increased utilization is very welcome; lack of access to mental health care is an ongoing concern.
My company is “investing” in telehealth. For now, just for Urgent Care. In the future we’ll decide on adding PCP, Dermatology, Behavioral Health (BH). I think the expensive one out of these will be BH. Urgent care I will monitor along side of ER and UC live visits to see if there is a dent and report back. Setting a reminder to update this after Q1 2023.
So do some companies not allow telehealth for some categories?
If my health insurer didn’t allow telehealth for mental health, I wouldn’t be able to access mental health care. Weekly appointments would take at least 2 hours of my work day. (I swear everything is 30 minutes away in this town.) Weekly appointments also mostly keep me able to work. If I didn’t have regular therapy I’m pretty sure I would have officially had a breakdown that would have prevented me from working by now. Telehealth means my time away from work is limited to the one hour of my appointment. I can use my lunchtime for that. Yes, I am that close to the edge that having to work an hour late every week would over time add up and push me over.
Well, they have to allow it (Modifier 95 and CR iirc) for now - thanks to Covid - Families First Coronavirus Response Act (FFCRA). But this may expire soon.
My MH provider doesn’t bill via insurance but I can use my HSA or cash - however, my company covers telehealth for MH but it is limited and sort of expensive (thus why we are looking into the MH via the telehealth provider). I think utilization will increase more than the savings in costs however because of situations like yours.
What exactly do you mean by companies? If you mean insurance carriers, I’d assume telehealth has to be allowed for most categories now due to Mental Health Parity whereby a mental health claim needs to be treated the same as any other condition (more or less). That being said, it could vary by large group vs small group vs individual.
If you mean your employer, it will likely depend on if your company is self-insured or fully insured. Fully insured is going to have to follow all the laws and regulations so it is likely that MH telehealth will be covered SAAOD (same as any other disease). A self-funded employer is able to build a plan design that avoids many health insurance mandates. In that case, it is entirely possible for an employer to choose not to offer coverage for MH telehealth visits.
I was thinking insurance companies but good point about self funded employers. I think employers have even more reason to cover telehealth for whatever reason just because it keeps people working.
