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Insurance Carriers Embrace Telehealth Part I — Medicare Advantage

Posted by Michael Greiwe, MD | February 9, 2020 |
Michael Greiwe, MD

20 million Americans enrolled in Medicare are about to embrace telehealth. The Bipartisan Budget Act of 2018 takes effect this year, and with it, Medicare Advantage customers will have access to telemedicine services to improve their lives.

Medicare Slow to Adopt Telemedicine

In past years, Medicare was slow to adapt to the new trends showing a growing interest in telemedicine. Kaiser Health News published an article in 2015 pointing out the obvious; despite the fact that telemedicine has been available for 20-years, the organization has been traditionally reluctant to embrace these tools. Data from 2012 showed:

  • Less than one percent of Medicare beneficiaries used these tools.
  • Medicare reimbursed about $5 million for telemedicine services.
  • Medicare’s total reimbursement for that year totaled $466 billion.

Traditional Medicare telehealth benefits have been limited to rural care providers and subscribers with limited brick-and-mortar clinical care.

But healthcare industry lobbyists and peer-reviewed-research has been hammering away at the facts; telemedicine reduces costly emergency treatment and increases access to care, particularly for the chronic diseases so prevalent in the elderly population.

In 2020, it appears that the nation’s largest public payer is finally paying attention.

Medicare Supports Telehealth Services in 2020

The Bipartisan Budget Act of 2018 goes into effect this year. With the new law comes increasing access to remote healthcare services. Traditionally, Medicare pays private plans such as Medicare Advantage to offer the same types of standard benefits as the ones covered under traditional Medicare plans. The Medicare Advantage plans have the same originating site restrictions on care delivery via telemedicine that traditional Medicare demands.

Under the prior rules, Medicare Advantage can offer additional telehealth services not covered by standard Medicare. But they have not taken advantage of this leeway, primarily, according to AARP, because any “extra” or supplemental telemedicine services would require an additional premium — something most fixed income seniors are loath to do.

However, implementation of the Bipartisan Budget Act of 2018 could be the game changer many telehealth advocates have been waiting for.

Greater Access to Telehealth Under Medicare Advantage

This year the number of telehealth services offered under Medicare Advantage is expected to rise. That’s because new rules allow Medicare Advantage to offer telehealth as a part of their basic benefits package with no supplemental costs. AARP says:

“Specifically, Medicare will cover the cost of extra telehealth services that traditional Medicare does not offer as part of its payment to MA plans—in addition to paying for telehealth services that traditional Medicare allows.”

CMS recently recommend their suggestions for implementation of these new laws, and they include giving Medicare Advantage discretion in deciding what types of telemedicine services to offer under the new law. This could open the floodgate to a plethora of new connected health services for rural and urban subscribers.

Insurance Carriers Embrace Telehealth Part I — Medicare Advantage

While this won’t eliminate the desire for the traditional on-site visit for some seniors (and some doctors, for that matter), it will allow elderly patients to receive care in their homes without the added cost and risk of traveling to a physician office.

With these new benefits, Medicare Advantage enrollees will have access to the latest technology and more convenient care. But will the nation’s elderly patients even consider something other than a traditional visit?

Telehealth and Senior Health

The question is whether seniors will take advantage of telehealth services. We can look to a study last year from the University of Michigan to determine the impact of the new telehealth rules. The National Poll on Healthy Aging looked at results from 2,200 study respondents’ ages 50 to 80. They found that, of those that had tried telehealth services, less than one-half compared it favorably to an in-house clinical visit. More than half said they felt they received better care when the doctor visit was face-to-face. When asked why, the survey respondents said that they communicated better with their clinician while also spending more time receiving care.

But it turns out that; of the full sample size only four percent had received treatment in the past year via a virtual house call. Just 31% said their doctors did not offer telehealth; another 55% said they simply didn’t know.

A 2019 study showed that seniors are interested in technologies like telehealth that can help them age in place. But the same study showed that our elderly patients could quickly grow frustrated with technology if they struggle to understand it. Despite this, a Pew Research study last year showed adults aged 60 and over spending more then half of their daily leisure time in front of TV, computers, cellphones, or other digital device. Screen time for all adults aged 60 and up is increasing and this data expands across genders and educational levels.

Pew found that this increase in screen time has coincided with an overall increase in the adoption rate of technology by elderly Americans. In 2000, 14% of Americans aged 65 and older were Internet users. Today, 73% of that age bracket frequents the Internet.

Forbes suggests that more senior Americans own technology than actually use these tools regularly. Given that remote patient monitoring and telemedicine can support senior living, healthcare and insurance providers must take steps to ensure the use of technology tools to improve care delivery by adding training into clinical workflows. Elderly patients must be introduced to these tools gradually, and clinical providers must ensure they understand the best use of telemedicine along with the benefits of these services.

One thing seems certain; technology literacy is an issue thwarting widespread telemedicine adoption in adults’ aged 65 and up. While Medicare and Medicare Advantage is loosening restrictions on reimbursement, the job is now up to the caretakers themselves to embrace the benefits of telehealth for their practice and patients.

Ready for Telemedicine in Your Physician Practice?

If your practice is considering telemedicine, there has never been a better time. These new telehealth benefits can provide your practice with new service line opportunities — and more convenient care for your patients. OrthoLive can help. Talk to us today about your virtual care delivery options.




Topics: "telehealth", "telemedicine", Medicare, telehealth cost, AARP, insurance, payers, Medicare Advantage, seniors

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