We’ve shared before how we’re anxiously waiting to see how telehealth will be treated in upcoming contract hospital-insurer negotiations. Now, Congress is debating how to expand access to telehealth as the pandemic’s intensity wanes. One of the key questions in this discussion is about compensation for doctors who see patients via telehealth; specifically, reimbursement via Medicare.
Enter Modern Healthcare’s recent recap of the situation. Before the COVID-19 pandemic, telehealth utilization was so low that it might as well have been run via an AOL account. A common misperception, though, is that this underutilization was primarily driven by reluctance on the part of hospitals or patients to engage with one another virtually. In reality, the most significant barrier to widespread adoption of telehealth was insurers allowing physicians to get reimbursed for providing care remotely vs. an in-person visit.
Before the pandemic, Medicare’s provider reimbursement for telehealth was a princely $15—a rate that didn’t even cover the cost of submitting an insurance claim. However, during the pandemic, Congress recognized the value of telehealth, and passed legislation to support it. So insurers had to cover telehealth visits at the same rates as in-person visits – also known as “parity.”
But now, as the pandemic wanes, the question is: What happens to telehealth? Patients and providers like it. But insurers are grumbling about continuing to pay for it. In fact, they’d like to revert to that $15 reimbursement rate, according to the article. Their reason? That patients will “overutilize” telehealth. (Read: costing insurers more money.)
In the end, it will be up to Congress to make the ruling. Will Congress force insurers’ hand into paying providers equally for telehealth as in-person visits? We think it’s the only reasonable decision.
