Telehealth Faces Legal Obstacles Before It Can Take Off

Recent proposed government expansion of telehealth services is facing obstacles ranging from how to license doctors performing telehealth to how to pay for the services.

Telehealth has generally been offered to rural patients so they don’t have to travel long distances to see their provider in person. The proposed changes, however, will let Medicare Advantage plans expand telehealth services to any patient regardless of their location.

The proposal would take effect in 2020. At that time, Medicare managed plans will be able to expand their telehealth offerings, treating them as basic plan benefits rather than the current route of paying for telehealth via discretionary funds. Currently, Medicare telehealth coverage is limited to a certain geographic area and forces patients to get these services in a healthcare facility rather than at home.

The expansion would be good for patients, but confusion over reimbursement could throw a monkey wrench into the works, potentially derailing the expansion.

American Well Chief Executive Officer Roy Schoenberg says he expects that the first two years of the expansion to be confusing. For one thing, Schoenberg said, healthcare providers aren’t going to be sure if they’ll be paid for providing telehealth services.

“If you know there’s a 100 percent chance you’ll get paid for seeing a patient in person, but only a 99 percent for treating them through telehealth, you’ll favor the in-person visit,” Schoenberg said.

Another potential problem is that providers will have to contend with different state laws governing how medical care can be provided. Most states require physicians to be licensed in the states where their patients live; therefore, someone like a cancer patient in Wyoming would have trouble getting services from a specialist at Minnesota’s Mayo Clinic.

The Centers for Medicare & Medicaid Services provided a very broad definition of how plans could deliver telehealth services, ranging from secure messaging to artificial intelligence chatbots. These new definitions are designed to build flexibility for Medicare Advantage plans, but they may create confusion if and when these regulations clash with those of other parts of the Medicare program.

The proposed boost in telehealth coverage will almost certainly spawn new technology to make delivery of telehealth services efficient, user-friendly, and cost-effective.

The story was originally posted on Bloomberg.