Good news for Americans who use Medicare Advantage.
The Trump administration is proposing a new Medicare rule that will enable more Medicare Advantage enrollees to access telemedicine, a form of health care delivery that uses information technology and telecommunications tools to deliver traditional medical care to patients. This is especially helpful to patients living in remote areas of the country.
This change will free up private insurance plans to meet patients’ individual needs in a more cost-efficient way.
Under the proposed rule, beginning in 2020, Medicare Advantage plans will have the option to offer “clinically appropriate” telemedicine services as a basic benefit in their plans. This change will let seniors and those with disabilities enrolled in Medicare Advantage plans consult with physicians and specialists in the comfort of their own homes.
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Previously, only rural Medicare Advantage patients with qualifying conditions and at designated locations could make use of the telemedicine benefit.
This new policy holds great promise for a popular and growing part of the Medicare program. Enrollment in Medicare Advantage, the Medicare system of competing private health plans, increased fourfold from 5 million in 2004 to over 20 million in 2018 and is projected to exceed 30 million by 2030.
Home-based patient care with access to telemedicine services is a high-quality option for aging Americans and citizens with disabilities. It can speed up access to regular and timely consultations, particularly among those who need frequent monitoring because they suffer, as most Medicare enrollees do, from chronic medical conditions.
Today, for a variety of reasons, including a growing shortage of primary care doctors, the new patient wait for a person-to-person physician visit averages 24 days in some parts of the country. Expanded telemedicine is a way for seniors to get around this frustrating problem.
This is the Trump administration’s third major telemedicine initiative.
On Oct. 31, the Centers for Medicare & Medicaid Services issued a final rule expanding Medicare’s home health payment for remote patient monitoring—a form of telemedicine—provided by Medicare’s home care agencies.
Another final rule proposed by the Centers for Medicare & Medicaid Services would modify the Medicare physician fee schedule and would update reimbursement codes for telemedicine services in order to grant Medicare payment for the assessment of remote patient images and video, as well as patients who “check in” with their physician to determine if they need an in-person visit.
Telemedicine has great potential to reduce health care costs. According to U.S. News & World Report, the insurance cost of an average telemedicine appointment amounts to roughly $45, compared to the “$120 to $125 for a typical office visit.” Visits to the emergency room can cost somewhere in the ballpark of $1,200 or more.
Telemedicine technology, if effectively used in managing patient conditions, can also reduce the number of hospital readmissions and hospital costs among the chronically ill.
Beyond its cost control potential, telemedicine can deliver better patient outcomes. Researchers writing in Diabetes Research and Clinical Practice (2016) reviewed the outcomes for 9,258 diabetic patients and found more successful diabetes management for the 4,607 who received telemedicine care compared to the remainder who received conventional care.
Telemedicine is in growing demand, not only for Medicare, but also for Medicaid and employer-based coverage. According to a Kaiser Family Foundation survey, 74 percent of large firms offered telemedicine benefits in 2018. With employer health care costs projected to rise by 6 percent in 2019, employers are increasingly offering telemedicine benefits as a means to decrease costs.
Telemedicine is gaining acceptance as a standard health care delivery option, recognized by medical boards in states around the country. Telemedicine expands patient access to timely care, in many cases linking local doctors and patients to the most renowned medical specialists in the nation.
And its expansion cannot come too soon. With 10,000 baby boomers retiring each day, the demand for medical services in Medicare is increasing dramatically. This latest Trump initiative holds the potential to broaden access while decreasing the costs associated with rapidly rising demand.