The momentum of telemedicine is increasing

The momentum of telemedicine has been exponential over the past three years and has become the focus of many healthcare investment firms. As delivery and reimbursement in healthcare change, the focus of telehealth has been one of the biggest forces, both in the public, and private sectors to deliver a reduction in costs and increase patients’ access. There is a growing demand for convenience, innovation and personalized care from all parties involved, especially patients.

So are the disruptors

In eye care, there has been the introduction of many technological disruptors which are misconstrued as “telehealth” options for patients. Eye care practitioners are now reluctant to embrace telemedicine because of how invasive these disrupters have been. To be clear, telemedicine should manage patient care through innovation, especially for those patients that have chronic conditions which require daily, and/or weekly monitoring, such as ocular surface disorders, post ophthalmic surgical care, and age-related macular degeneration. Trying to replace the refraction portion of a comprehensive eye exam in efforts to sell product can hardly be called telemedicine.

In a study released by the Journal of American Medical Association called, “Supply and Perceived Demand for Teleophthalmology in Triage and Consultations in California Emergency Departments,“ concluded that telemedicine could play a role in mitigating coverage gaps in ophthalmic care in rural areas of California. Additionally, the Veterans Affairs utilizes telemedicine in diabetic care by imaging the fundus and then electronically sending the photos to an eye care specialist, including optometrists, for evaluation of changes in the blood vessels. Telemedicine does not replace the comprehensive eye examination, rather it enhances the patient experience by convenience and personalized care through technology.

MIPS

Starting January 1, 2017, all eligible providers, including optometrists will receive their Medicare reimbursements being graded from 1 to 100 on how they deliver outcome-based care through the final MACRA Rule. The Merit-Based Incentive Payment System (MIPS) encourages providers to use telemedicine to:

  • Monitoring health conditions of individuals to provide timely health care interventions.
  • Timely communication of test results, timely exchange of clinical information to patients and other providers, and use of telehealth.
  • Care Coordination with telemedicine, etc.

By simply utilizing telehealth, eye care practitioners can maximize their Medicare reimbursements with MIPS bonus points in the areas of:

  • Quality (60% of your MIPS score)
  • Advancing Care Information (25% of your MIPS score)
  • Improvement Activities (15% of your MIPS score)

Currently, there is a bipartisan effort in Congress to expand the telehealth services for Medicare via Telehealth Parity Act of 2017 (https://www.congress.gov/bill/115th-congress/house-bill/2550/text) and Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (https://www.congress.gov/bill/115th-congress/senate-bill/1016/all-info). Some of the provisions of these proposed legislations would include:

Telehealth Parity Act of 2017:

  • Removing geographic barriers to provide telehealth services in rural, underserved, and metropolitan areas
  • Expanding the list of providers eligible to provide telehealth services to include PTs, OTs, and speech language pathologists, among others
  • Expanding access to telestroke services
  • Allowing remote patient monitoring for those with chronic conditions including heart failure, chronic obstructive pulmonary disease, and diabetes
  • Allowing a beneficiary’s home to serve as a site of care for home dialysis, hospice care, eligible outpatient mental health services, and home health services

Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act:

  • Expansion of telehealth in ACOs, Medicare Advantage, and stroke treatment programs
  • Expansion of remote monitoring programs for people with chronic conditions
  • Definitions of reimbursable telehealth codes
  • Expansion of remote patient monitoring programs at community health centers and rural clinics