You Can Skype Your Doctor, But Insurers Will Pay Less For It

What if you could see your physician for a minor issue without having to drive there, find parking, or spend time in a waiting room? What if you could do it without leaving your desk?

Telemedicine—the practice of allowing people to speak with their medical practitioners via two-way video, text or email—makes this possible. In the U.S., more than half of hospitals now use some form of telemedicine, according to the American Telemedicine Association. And of patients who have not used a telemedicine service, 75% are interested in using one in lieu of an in-person medical visit, according to data from Software Advice, a software selection firm.

But while interest exists, insurance companies aren’t keeping pace. When it comes to telehealth, insurance reimbursements are 40% lower than reimbursements for in-person care, according to a recent policy brief from the Health Care Cost Institute.

The HCCI analyzed data from billions of claims from Aetna, Humana, Kaiser Permanente and United Healthcare for more than 50 million insured, using claims data for 2009 through 2013.

This RP-VITA robot enables physicians to "beam" themselves into hospitals to diagnose patients and offer medical advice during emergencies.

What they found is that differences in average reimbursements between telehealth and non-telehealth claims are substantial. Non-telehealth service reimbursements increased every year, rising from $57 to $61. In comparison, telehealth claim reimbursements rose from $60 to $68 from 2009 to 2011—and then dropped to $38 in 2013.

In some cases, charges for a telehealth visit were lower, but reimbursement was also lower. For instance, a psychiatric diagnostic interview examination was charged at $200 using telehealth and $288 for non-telehealth, on average, according to the report. Reimbursements were $77 for the telehealth visit and $105 for the in-person visit.

"It is possible that a few providers have figured out how to use telehealth technologies to reduce the cost of a psychiatric diagnostic interview, hopefully without compromising quality of patient care," says Fernando Wilson, Ph.D., associate professor with the College of Public Health at the University of Nebraska’s Medical Center and author of this study. "However, given our findings, many providers may have less incentive to invest in technologies that increase their cost of care even though they improve patient outcomes."

What does that mean for you, the consumer? It could mean that telehealth takes longer to achieve real growth. It could also mean that state legislation must continue to evolve. “The majority of states don’t specifically mandate that if you’re going to provide telehealth coverage, that reimbursement should be the same,” Wilson says. “Maybe that’s what’s going on.”

Telehealth has a strong potential to extend care to underserved rural populations, where it’s tougher for consumers to get to doctors for face-to-face appointments. “If there aren’t strong economic incentives to adopt tele-technologies, then we’re forgoing an opportunity to try to reduce these traditional urban/rural gaps in healthcare services,” Wilson says.

In the end, more research is needed. “Considering all the tele-policies that have been implemented over the last few years,” Wilson says, “trying to get a better understanding of what’s going on is going to be important.”

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