As the Medicare program expands telemedicine services, the opportunity may arise for sub-specialist pathologists to offer consultation services across state lines

More use of telemedicine across state borders has long been predicted as a way to improve access to care—particularly for patients in rural areas—as well as to give physicians and patients access to talented sub-specialists. Within the anatomic pathology profession, however, there are probably as many pathologists who view telemedicine across states lines to be a threat as there are pathologists who see it as an opportunity to raise the quality of care.

For its part, the Centers for Medicaid and Medicare Services (CMS) is taking a step forward in supporting the wider use of telemedicine. It is issuing new rules that expand reimbursement for remote patient services, a move that one day could benefit pathologists who provide sub-specialty pathology consultations with referring physicians across state lines.

CMS Added Seven Procedures to Its New Telehealth List

When final payment rules governing how Medicare will pay healthcare providers and suppliers in 2015 were released last October, CMS added seven procedures to the telehealth list of covered services, including annual wellness visits, psychotherapy services, and prolonged services in the office.

The American Telemedicine Association (ATA), which has long advocated for widespread use of telemedicine, praised the CMS for opening the door to greater access to telemedicine.

“It’s been a long time coming, but this ruling making signals a clear and bold step in the right direction for Medicare,” Jonathan Linkous, CEO of ATA, said in a statement. “This allows providers to use telemedicine technology to improve the cost and quality of healthcare delivery.”

Jonathon Linkous, CEO of the American Telemedicine Association

Jonathon Linkous, CEO of the American Telemedicine Association (ATA), praises the Centers for Medicare and Medicaid Services’ new rules expanding funding for telemedicine services. “This is an important change in CMS policy and attitude,” he said. “We hope it will encourage CMS and Congress to further open up all value-based payment plans to telehealth.” (Photo copyright ATA.)

What This Means for Pathologists

As the use of telemedicine becomes more common, states will be pressured to revise physician licensure laws to make it easier for out-of-state physicians to provide telemedicine services to in-state patients. For the medical laboratory profession, this might eventually make it possible for pathologists to one day be able to remotely monitor chronic patients using patient self-test devices that upload lab test results in real-time to their clinical laboratories.

For now, remote patient monitoring will continue to be available only to some Medicare patients. As Politico points out, CMS stopped short of dropping the provision requiring patients to be in a rural location to receive billable telemedicine services.

“We do not have authority to implement many of these revisions under the current statute,” Politico quoted CMS as stating. “The CMS Innovation Center is responsible for developing and testing new payment and service delivery models to lower costs and improve quality for Medicare, Medicaid, and CHIP beneficiaries. As part of that authority, the CMS Innovation Center can consider potential new payment and service delivery models to test changes to Medicare’s telehealth payment policies.”

In all, Medicare payments to telehealth are 0.8% higher in 2015.

Chronic-care Management Receives New Code: Causes Confusion

The CMS also added a new Current Procedural Terminology (CPT) code for chronic care management services. However, this change may not be as significant as first thought, because, as the ATA explained in a statement, “CMS has once again not allowed payment for data collection.”

In an article, Perry Payne, M.D., J.D., M.P.P., Assistant Research Professor in the Department of Health Policy at the George Washington University School of Public Health and Health Services (GW), and an adjunct at Howard Law, addressed the initial confusion over the Medicare rule allowing for payment for chronic-care management.

Perry Payne, M.D., J.D., M.P.P

Perry Payne, M.D., J.D., M.P.P. says the new CMS rules supporting telemedicine “present opportunities to offer telehealth services since one of the ways that providers can interact with patients to manage their chronic diseases is through telehealth and digital health systems.” (Photo copyright Howard University.)

“Some media outlets and organizations that support telemedicine are reporting that CMS is paying for remote monitoring of chronic care management patients because of a new rule that offers providers reimbursement for non-visit based services for chronic care management patients,” Payne wrote. “However, this change is not focused on telehealth or digital health services as it can include many other activities.”

Health Plans Support Telemedicine

Greater CMS reimbursement for telemedicine likely will be the impetus needed for more private payers to jump on the telemedicine bandwagon. For now, Aetna, Highmark, and Cigna are among the private insurers reimbursing for telemedicine and telehealth services, Healthcare IT News reported.

Highmark has been an early adopter of telemedicine. The private payer first offered primary care visits through Teladoc to beneficiaries in 2012. In January 2015, Highmark became the first health insurer in the country to offer teledermatology as a covered benefit.

“We need to make sure our members get the right care in the right setting, and telemedicine is a key tool to help make that setting more patient-centered,” said Donald R. Fischer, M.D., MBA, Highmark Senior Vice President and Chief Medical Officer, in a company statement. “Telemedicine is a resource that is critical to transforming the delivery of healthcare. It ensures faster access to high-quality healthcare while also helping to control costs.”

Donald R. Fischer, M.D., MBA

Donald R. Fischer, M.D., MBA, Senior Vice President and Chief Medical Officer Highmark, Inc., urges the healthcare industry to expand the use of telemedicine. “Telemedicine is a resource that is critical to transforming the delivery of health care,” says Fischer, whose company became the first private insurer in the country to offer teledermatology as a covered benefit. “It ensures faster access to high-quality health care while also helping to control costs.” (Photo copyright Highmark Inc.)

Texas Erects Barriers to Telemedicine

Telemedicine, however, still remains controversial. In April, the Texas Medical Board voted to rein in the practice of telemedicine in Texas by requiring physicians to conduct in-person visits with patients before providing diagnoses or prescribing drugs by phone or video, the Houston Chronicle reported. The only exception would be if a patient is at a healthcare facility such as a hospital, clinic, or pharmacy, and has another healthcare professional with them. Mental health visits are excluded from the rules.

“What the board is trying to do is really to keep patients safe,” Douglas W. Curran, M.D., a family physician and Vice Chair of the Texas Medical Association Board of Trustees, told the Houston Chronicle. “They want patients to be seen and evaluated so that patients can get the very best car possible. And I happen to agree with that.”

Opportunities for Pathologists

What pathologist will want to note is that CMS is taking another forward step in supporting the expanded use of telemedicine. That will put pressure on states to revise their physician licensure laws to make it easier for out-of-state physicians to provide telemedicine services to in-state patients. As that happens, this trend may open the door for more pathologists to provide sub-specialty pathology consultations with referring physicians across state lines and do patient consults as well (that are reimbursable to the consulting pathologists).

—Andrea Downing Peck

Related Information:

CMS Approves American Telemedicine Association’s Request to Expand Telehealth Coverage

CMS Expands Telehealth Reimbursement in New Rule

Maintaining its Commitment to Telemedicine, Highmark Leads the Way in Providing Coverage for Additional Services

Politico Morning eHealth

Private Payers Look to Telemedicine

Physician Fee Schedule

CMS Releases Final Payment Rules For Medicare Program

Telemedicine Gets a Commercial Payer with Iagnosis, Highmark Collaboration

New CMS Guidelines on Telemedicine Reimbursement Include ‘Significant Additional Coverage’

Politico Morning eHealth

CMS Boosts Telehealth 2015 Physician Pay Schedule

Update on CMS Payment Decisions: Two Steps Forward, One Back

What Physicians Need to Know About Medicare’s New Telemedicine Reimbursement Rules

Texas Medical Board Votes to Curtail Telemedicine