How Much Does Telemedicine Cost?

Brad
0
on Apr 21, 2020

Over the past year, we have seen a boom in the use of telemedicine and telehealth services. Doctors in all fields of healthcare, and patients alike, have seen the utility and convenience of telemedicine. For patients, telehealth may offer convenient care that is accessible while still staying comprehensive and personal. The most common question with telemedicine is “How much does it cost?” Read on to learn more about the costs and reimbursements involved with this emerging technology.

What is Telemedicine?

Synchronous Telemedicine

Telemedicine refers to providing patients with care, including diagnosis, treatment, and consultation, through any telecommunications technology. While that initially meant phone calls, telehealth today is most recognized as video conferencing via smartphone, computer, or tablet. This is known as real-time or synchronous telemedicine, and it allows a patient to receive just about the same level and type of care as an in-person appointment. Alternate forms of synchronous telemedicine can also take place in a physician’s office, where a patient can speak with a physician via webcam while an assistant (sometimes known as a telepresenter) can provide hands-on care, like performing a physical exam or recording the patient’s blood pressure.[1]

Asynchronus Telemedicine

The other type is store-and-forward or asynchronous telemedicine. Unlike synchronous telemedicine, which involves real-time audiovisual interaction, store-and-forward is more akin to sending and receiving emails. The patient can send text, videos, photos, and other information to the doctor, and the doctor can reply when they have the opportunity, and vice versa. This is more convenient for patients or clinicians who may have a busy schedule or are otherwise unable to schedule real-time sessions. Asynchronous telemedicine is commonly used in radiology, dermatology, and pathology.[1]

Remote Monitoring

One type of telemedicine that medical professionals have embraced is remote monitoring. Also known as self-testing or self-monitoring, remote monitoring allows a patient to send health and clinical signs and data to a doctor via their own monitoring devices. This is most common among patients with diabetes, who can use continuous glucose monitors to track blood sugar levels throughout the day while relaying the data to a doctor. Remote monitoring may also be used for other conditions, including asthma and heart disease. While remote monitoring does run the potential risk of inaccurate testing, most results are considered to be on par with professional tests done in a clinic.[2]

As you can see, telehealth and telemedicine can be used in a variety of ways and can involve all three of the above. A patient may schedule a real-time appointment to receive a diagnosis or treatment plan. This may be followed up with store-and-forward consultations to determine how a patient is doing. Furthermore, telemedicine can be used in conjunction with in-person appointments to provide more comprehensive care. Now, how are they covered by patients’ insurance, Medicaid, and Medicare?

Reimbursement for Telemedicine

Telemedicine and Medicare

EXPANSION OF TELEHEALTH WITH 1135 WAIVER: Under this waiver, Medicare can pay for office, hospital, and other visits are done via telehealth in all 50 states, including visits in which the patient is doing a real-time video appointment, from their home starting March 6, 2020.[6] Currently, there is no end date for this waiver and Beam’s live video chat is supported.

Prior to this waiver, Medicare could only pay for telehealth on a limited basis: when the person receiving the service is in a designated rural area and when they leave their home and go to a clinic, hospital, or certain other types of medical facilities for the service.

Is telemedicine covered by private insurance and Medicaid?

Many states’ Medicaid plans are making provisions for telemedicine. Most states allow every telemedicine visit to be charged as if it were an in-person visit. That being said, some states have certain criteria that must be met in order for the visit to qualify. For example, in Alabama, a telemedicine visit must be a synchronous, live video chat (like Beam Health’s live video chat feature) in order to be reimbursable.[7] Few states have more restrictive rules that only reimburse for telemedicine as long as it fits the criteria of what is considered acceptable use of telemedicine. Massachusetts will only provide Medicaid coverage for telemedicine as long as it fits outpatient services such as opioid treatment (although at the time of writing this, the Massachusetts House of Representatives has introduced a bill for more comprehensive telemedicine coverage in relation to Medicaid). Visit our state-by-state Medicaid guide for telemedicine to see your state’s guidelines.

The Cost of Telemedicine

An initial study from 2014 found that the average number of telehealth visits was about 1.3 per year. Over the past year, telehealth made up approximately 30% of all outpatient visits.[3]

This rise has seen providers and patients grown exponentially more comfortable with the technology, with many patients now expecting their providers to offer telemedicine. About 83 percent of the time, the patient’s issues can be resolved with just one telehealth visit, most often involving cases of sinusitis, cold and flu, and urinary tract infections.[4] So how much does it cost for a provider to offer this service?

The cost of telemedicine all depends on what is the provider receiving from their telemedicine platform. Some platforms offer telemedicine for as low as $5 a visit, but bargain bin platforms such as these don’t offer HIPAA compliance, HD video, or a secure server that protects patient information. For instance, Beam offers HD video conferencing that is HIPAA compliant and a secure database that protects patient information through AWS, which is all standard, for custom pricing that fits each practice’s individual needs. It is important to know the differences between the various platforms before you make a decision on which fits your practice’s needs.

Other determining factors that aren’t taken into account are the potential savings involved to both patients and doctors. Data over the past year shows that, besides being close to a third of all outpatient visits, telemedicine also reduced the number of no-shows. This intrinsic value must be taken into account as practices are seeing an epidemic in patient leakage. Patients, particularly those in small, rural, and underserved communities, do not have to spend money to travel to a specialist. They also do not have to take time off from work in order to visit the doctor. Similarly, doctors do not have to worry about travel expenses to visit more remote communities, while subspecialists who often have to travel to multiple sites can see patients in the comfort of home.

To summarize, over the past year we have seen virtual health being incorporated more and more into standard healthcare practices with insurance companies, Medicaid, and Medicare making room for these services under their collective umbrellas of coverage. It is important to know your state’s individual practices regarding parity and Medicaid, but it’s safe to assume that the majority of the country can accept telemedical visits the same way they would in-person visits, and thus charge patients their regular co-pay.

For providers looking into telehealth and telemedicine, besides knowing local regulations, it’s vital to find a telehealth partner who will meet your needs, and meet the state insurance and Medicaid requirements for coverage. Beam Health’s synchronous, live video chat feature does just that, and we also offer custom pricing so each practice’s individual needs are indeed met.

Beam isn’t just a telehealth and telemedicine platform; we are the first digital operations platform built for doctors. This means along with secure HD, HIPAA compliant telemedicine, we also offer doctors a suite of tools that improve a practice’s marketing, customer service, and systems, as well as custom integrations with every EHR. To learn more about Beam Health, visit us here or to speak with an implementation specialist set up a demo here!

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