Connect with us

Politics

The battle over telehealth prices after the coronavirus pandemic

Published

on

  • Doctors are seeing patients over phone and video during the pandemic so they can protect from coronavirus infection while still being able to help patients who are sick.
  • Policymakers changed rules for telehealth, making more virtual visits possible, and letting doctors get paid.
  • There’s a debate over whether to pay for virtual visits at the same rate as in-person visits. That decision will affect how much people use healthcare. 
  • For more stories like this, sign up here for our healthcare newsletter Dispensed.

Healthcare spending in the US is higher than any other country in the world, at more than $3.6 trillion annually, or $11,000 per person.

But during the coronavirus pandemic, spending on healthcare slowed significantly as government officials pushed people to stay home and pressured hospitals to put off care that wasn’t urgent. Instead of heading to the doctor’s office, many patients started seeing their physicians over phone, by video, and even through chat boxes on smartphones and tablets. 

Fueling the shift to virtual care, Congress, the Trump administration, and private insurers all made it easier for doctors to get paid for telephone and video visits with patients. Medicare started paying doctors the same rate for talking to patients on the phone as it would have for an in-person visit.

Now, there’s a debate over how much medical care should remain virtual after the pandemic, and how much doctors should be paid for it. The outcome stands to shape the future of how all of us get healthcare. Supporters say increased access to telehealth would improve care for patients and potentially lower costs. But others warn it could drive up costs for patients, insurers, and taxpayers, harm patient care, and even contribute to fraud. 

“It is crystal clear that we need to continue telehealth,” said Seema Verma, the Trump administration official who oversees Medicare. “I think in what capacity, how we do reimbursement, determining what types of medicine it works best in — all of that is going to continue to evolve.” 

Read more: ‘There’s been a paradigm shift’: Telemedicine lobbying soars nearly 200% in push to capitalize on coronavirus pandemic and make permanent changes to Washington policy

There’s a debate over how much to charge

Before the pandemic, private insurers generally charged patients a copay for seeing their doctor over video and generally didn’t pay medical providers the same rate as they would for an in-person visit. Medicare mostly made telehealth available only to patients in rural areas, and made them go to a medical facility for a video visit, rather than allowing them to do it from home. 

Before Medicare let more people use telemedicine during the pandemic, an average of 13,000 patients a week were getting virtual visits. By April 25, that jumped to 1.5 million a week, according to CMS. The agency has seen 9.5 million telemedicine visits in all since the expansion.

The Congressional Budget Office has said that if doctors end up billing for phone or video visits and then still have in-person visit on top of that, then healthcare spending would go up. If telehealth is reimbursed at a lower rate, then virtual visits could save money.

CBO estimated that the changes Congress made to telehealth during the pandemic would increase Medicare spending by about $2 billion from this year through 2022. The agency, however, has overestimated the cost of expanding telehealth before. 

Verma and other top officials will weigh decisions about cost at the agency she oversees, the Centers for Medicare and Medicaid Services. She said virtual visits could help replace some in-person visits, but that she understood the cost concerns.

Once the temporary changes during the pandemic emergency are over, the agency will have authority to decide certain Medicare rates, but Verma said Congress has to decide which providers can use video visits and whether patients can see a doctor from home. States have authority over private insurers, as does Congress. Insurers negotiate the prices they pay with healthcare providers. 

Verma said she wants to strike a balance so that telehealth will make care more accessible and affordable, improve quality, and make patients healthier.

“You don’t want to make [reimbursement] so low that providers don’t want to offer [telehealth], that they actually have a financial incentive to have people come into the office,” she said. “There has to be an incentive for the provider to continue to offer these services.”

FILE - In this April 19, 2020, file photo, Administrator of the Centers for Medicare and Medicaid Services Seema Verma speaks during a coronavirus task force briefing at the White House in Washington. Seniors are at greater risk from COVID-19, and they now face added anxiety due to delays obtaining Medicare coverage. Advocates for older people say the main problem involves certain applications for Medicare’s “Part B” coverage for outpatient care. The delays stem from the closure of local Social Security offices to protect workers and the public in the pandemic.  (AP Photo/Patrick Semansky, File)

Seema Verma, administrator at the Centers for Medicare and Medicaid Services.

Associated Press


She said that telehealth can also play a bigger role as doctors and health systems move away from a system where they get paid for each visit or procedure, and instead get paid to keep patients healthier, a shift known as value-based care.

Dr. Ateev Mehrotra, who teaches healthcare policy at Harvard Medical School, has found that video and phone visits may increase healthcare spending. When it becomes easier for people to go to the doctor, they tend to go more often, and that raises costs. 

“The advantage of telemedicine and its ability to make healthcare so convenient could be its achilles heel,” Mehrotra said. 

Still, he said, there are other considerations, including whether using more healthcare helps patients. There’s not much a doctor can do for a patient with a mild cold but to tell them to rest and eat chicken soup, he said. But if a person with diabetes gets more frequent care, that can help them avoid amputations and heart attacks. 

The pandemic is allowing experimentation

Proponents of increasing virtual visits hope the pandemic will help them show its value. A Merrit Hawkins survey found 48% of doctors now say they’ve treated their patients virtually, a jump from 18% in 2018. 

Supporters point to benefits for patients, such as making care more convenient and easier to access for people in rural areas. Doctors could also pair virtual visits with technology that patients can use at home to measure blood pressure, heart rate, or sleep.

Dr. Bud Pierce, an oncologist in Oregon, provides lab work and chemo for patients, but also does regular check ins over Zoom. Because his patients are seriously ill, they quickly lose energy and can’t drive, and so getting help virtually means they don’t have to arrange for transportation. 

“I think it’s a big improvement to be able to see your patient, to talk to them, and to be able to see them in their home and not to require them to come in,” he said. 

Read more: Doctors are getting creative about how they care for their patients amid the pandemic. 3 physicians share what they’re doing — and the challenges they still face.

Policymakers are deciding what to do

The $2 trillion CARES Act President Donald Trump signed into law in March relaxed telehealth restrictions so more people could use it in more places, including at home. The changes will last as long as the coronavirus-related public health emergency is in effect.

Because healthcare providers don’t know how long they’ll be allowed to use telehealth, they’re pushing for a permanent overhaul. They want patients to keep being able to see doctors from home, instead of having to go to a designated site. They also want Congress to give the administration power to decide which healthcare providers can get paid for telehealth. 

Kerry Palakanis

Kerry Palakanis, executive director for Connect Care Operations at Intermountain Healthcare

Courtesy Intermountain Healthcare


“The public health emergency and national emergency are the only things allowing us to continue at the pace we are at,” said Kerry Palakanis, executive director for Connect Care Operations at Intermountain Healthcare. “If they are stopped, we go back to the dark ages of telehealth where we have many barriers associated with our ability to practice fluidly.”

Telehealth advocates created a task force to study virtual medicine, including its cost, and will lobby Congress. There’s bipartisan support to make some changes to telehealth permanent, and some lawmakers want to add even more requirements such as forcing private insurers to cover phone and video visits at the same rate as in-person visits. Some states are already requiring this. 

Insurers don’t have to wait for the government to make all changes, and many of them support having more telehealth. But they oppose being forced to pay the same price for a virtual visit as an in-person visit, and instead want to pay less.

“Everything about it on the provider’s side is cheaper, therefore in a world that makes sense it should be cheaper than in-person,” said James Gelfand, a lobbyist for the Erisa Industry Committee, which represents large employers. “If you could get paid more for doing less, wouldn’t you?” 

Providers see it differently.

“There’s a large percentage of activities that we do that are equally effective and the visit is equally good, whether it is in person or over video,” Palakanis said. “If the service is equivocal, why would we discount the reimbursement for care?”

A push for an overhaul to how providers get paid

Dr. Wyatt Decker, CEO of OptumHealth, said the company thinks more people will continue to be able to use telehealth after the pandemic is over. OptumHealth is the health services arm of UnitedHealth Group, America’s largest health insurer. 

Wyatt Decker, CEO of OptumHeath

OptumHealth CEO Wyatt Decker

UnitedHealth Group


“I think there’s an enormous potential for savings,” Decker said. “In order to capture it we have to be thoughtful about how to engage with people.” 

Decker said OptumHealth is thinking about the approach in terms of “layers” of care. The company set up a symptom checker that helps patients assess whether they need help from a nurse or doctor, and whether to get a virtual or in-person visit. 

Read more: How the coronavirus will permanently reshape the healthcare industry, according to 26 top industry leaders

“By layering this thoughtfully, I think we’ll be able to create the right level of care at the right place and the right time,” Decker said.

LoadingSomething is loading.
Continue Reading
Advertisement Find your dream job

Trending