Conflict recently divided a US Congress hearing – where it was agreed that using telemedicine, home visits, remote monitoring, and other strategies allowing patients to get more care at home, should be encouraged – as lawmakers and witnesses squabbled about whether some home services should cost less than in-person visits.
Medpage Today reports that at last week’s hearing held by the House Ways & Means Committee, Ateev Mehrotra, MD, MPH, professor of healthcare policy and medicine at Harvard Medical School, said payments for care in the Medicare programme “are based on the time a clinician takes to provide the care, and the associated space, staff and equipment”.
“If something costs less, it should be paid less. While it does require some overhead, telehealth visits do not require the same practice expenses.”
Mehrotra said some clinicians were objecting. “They say their practice expenses have remained the same because they provide both in-person visits and telehealth visits. I disagree. I don’t think Medicare should cross-subsidise in-person visits with telehealth because it will create distortions in care. It will give virtual-only companies an unnecessary competitive advantage.
“It will also incentivise clinicians to give up their physical practice. Already we see that roughly 13% of mental health specialists have given up their physical office and gone virtual-only.”
Resisting the lower telehealth payments was healthcare provider Drew Ferguson, DDS.
“There’s a disconnect between what is said theoretically and what (happens) in practice,” he said. “That overhead still exists, the building still exists, the staff still exists, the electric bill still exists … I don’t think that simply saying, ‘We’re just going to have telehealth and we’re going to pay less’ – I don’t think that’s going to work. I think it’s going to exacerbate the problem of people being willing to go into private practice and practice in rural areas.”
At a tele-hospitalist programme at Intermountain Healthcare subsidiary Castell in Salt Lake City, Utah, in-home visits are offered by nurses and other healthcare providers – rolled into Intermountain’s “hospital at home” programme, which mostly involves virtual care.
“The billed amount for telehealth can ideally be lower because we don’t have the overheads – unless we need to have someone go into the home,” said Nathan Starr DO, lead hospitalist for the tele-hospitalist programme.
“So all of that is rolled into the payment for hospital-at-home, and we do have providers, caregivers, whether community paramedics or nurses, in the home to do the physical assessment… we can do everything else virtually. It’s a model that can be really successful, but there is not a great answer yet to that question.”
On whether he was seeing pushback from physicians about increasing the amount of care done at home, he said: “Not pushback, but I think it is a new way of doing things and that makes it challenging.”
The hearing also included testimony from patients who receive care at home, including Bell Maddux of Pennsylvania, who manages her own in-home dialysis for chronic kidney disease.
On whether she saw any difference in the level of care or treatment she gets at home compared with when she went to a dialysis clinic several days a week, she said: “At the clinic, there was a tremendous amount of non-patient-care-related pressure for staff.
“For example, they had to get the patients connected in a certain timeframe because they needed to have a certain number of patients dialysed in a specific time-frame. So they would rush through putting needles in…”
But now that she is doing home dialysis, “my doctor and my dialysis nurse… are almost like friends at this point”.
“I think that’s valuable.”
See more from MedicalBrief archives:
Ensuring equitable access to fast-expanding virtual healthcare
New rules for Australian telehealth scripts
Seeking clarity from HPCSA on telehealth