Telemedicine Acceleration

New York State Medicaid Update

The New York State's Department of Health's monthly update came out for September.  The document is attached.  Download September_7_2006_Medicaid_update.pdf.  On pages 23 and 24 of the document it discuss recent telemedicine advancements.  It states that effective for dates of service on and after Sept. 1, 2006, medically necessary emergency room and inpatient hospital consultation services are payable to physicians with a specialty designation providing consultations via an interactive audio and video telecommunication system.

According to this document Telemedicine system is an interactive audio and video telecommunications system that permits a "real time" interactive consultation service to take place between the physician and patient. 

Telemedicine is reimbursable when a patient is located at a spoke site and the needed specialist is located at a hub site.

The hub site is where the medical specialist is located.  The spoke site is the hospital where the referring health professional and patient are located. 

This document goes into a little more detail of what is covered.  It is not full reimbursement for telemedicine but it is making progress in the right direction. 

Colorado to Reimburse providers for Telemedicine

In July 1, 2006 the State of Colorado passed a bill to reimburse health providers for telemedicine services.  This decision was based on studies that show providers can save as much as $1mm in costs from a $150,000 initial outlay for telemedicine systems at rural practices.  They also state that Medicaid caseloads can be as much as 80 % of the total of those practices.  Gov. Bill Owens stated "Telemedicine means better access to state of the art care in communities where finding specialized help is often difficult." 

The study that they referenced was not quoted. 

This trend for Telemedicine reimbursement will continue to grow and become standard reimbursement practice from insurers. 

The State of Reimbursement in the US

The telemedicine information exchange has a list of the states with Medicaid and Private Payers listed for telemedicine reimbursement.  The link has been down for awhile now but I have been able to locate a paper copy of the list. 

The list is attached.  The nice think about this list is that it list the specific Private Payers who are reimbursing for Telemedicine by state. 

Download telemedicine_reimbursement_by_state.doc

Private Payer Remimbursement List

The AMD Telemedicine website has a Private Payer Reimbursement List by state.   There are currently 131 private payers  listed.  The list is comprised of:

• Telemedicine providers receiving private payer reimbursement
• Private payers providing reimbursement
• State legislation mandating private payer reimbursement of TM services

Reimbursement for Health-e-Access Program

The Health-e-Access Program is working with a number of 3rd party payers and government / state agencies to provide reimbursement for the telemedicine visits that take place under this program.  NYS is not a state that provides reimbursement on a broad scale so the HEA program has had to work with these Organizations to reimburse for these visits. 

The following organizations are providing reimbursement for the HEA program:

1. Excellus BlueCross and BlueShield
2. Preferred Care
   
3. Preferred Care Option - Medicaid Managed
   

4. MonroePlan (Blue Choice Option) - Medicaid Managed

5. Aetna- Nationwide

6. United Healthcare - Nationwide
   
7. Child Health Plus
8. Family Health Plus
   

It is the intent of the program to collect documentation and verify that the telemedicine visits are cost effective and provide the insurers with a positive economic benefit.   

Telemedicine Reimbursement

Reimbursement is the key to the growth and expansion of the telemedicine market.  In the US today there are 26 states that have either Medicaid reimbursement for telemedicine (by law or legislation) or by Private insurance legislation for telemedicine reimbursement according to the Telemedicine Reimbursement Report prepared by the Center for Telemedicine Law in October 2003 Download telemedreimbursementreport2003.pdf.  Their is a chart in the report that gives a general overview for a quick reference Download reimbursement_chart.doc . 

Their are 5 states listed in the report that have both Medicaid and Private Insurance Reimbursement. 
1.  Texas
2.  California
3.  Kentucky
4.  Louisiana
5.  Oklahoma

There are also additional States that since the report have legislated both Medicaid and 3rd Party reimbursement.
6.  North Carolina
7.  Colorado

The Telemedicine Exchange has a good resource for information regarding State Reimbursement and what 3rd Party payers reimburse for Telemedicine .  The link as of today is down but I have talked to the Exchange and they thought it would be fixed by the end of the week.

There are a number of factors that have driven reimbursement and will continue to drive Telemedicine Reimbursement in the future. 
1.  Providing specialty care for undeserved communities where distance and specialty care are issues.
2.  The 200 institutional networks that are operational in the US.
3.  The need / want of consumers to have more convenient health care.
4.  The need to reduce health care costs for all stakeholders.
5.  Improving technology and decreasing costs associated with that technology.

In the future States and Governmental coverage of medicine reimbursement will continue to grow.   As this transpires the telemedicine market will grow.  As the telemedicine market grows consumers will have access to better and more convenient tools / services to receive health care.