ATA CEO, Jon Linkous: Paying for Telemedicine in the United States
Of the $2.8 trillion that constitutes healthcare market in the U.S., there are five primary sources that support almost all telemedicine. All are rapidly expanding.
- Hospital and healthcare systems – Support comes from two areas. First, managed care, health home and Accountable Care plans allow providers the flexibility to pay for and use telemedicine wherever it is warranted. Almost 100 million Americans are now covered under these plans and the number is growing rapidly. Second, a growing number of hospitals and health systems use core funds to support telemedicine between facilities to lower costs by sharing specialty services and increase revenue from expanded referrals.
- Private, public and employer insurers – Every large health insurer in the U.S. is expanding coverage of telemedicine. Sixteen states currently mandate private insurance coverage and so far in 2013 thirteen more states have pending legislation (see http://www.americantelemed.org/docs/default-source/policy/state-telemedicine-legislation-matrix.pdf?sfvrsn=10)
- Federal Medicare – Medicare reimbursement is unlimited for remote imaging services. Live consults are reimbursed for patients in rural areas. In 2013 Congress is taking up several proposals to significantly expand this support. (For details of current Medicare policies for telemedicine see http://www.americantelemed.org/docs/default-source/policy/medicare-payment-of-telemedicine-and-telehealth-services.pdf?sfvrsn=14)
- State Medicaid Some Medicaid coverage is available in 44 states and so far this year three states are considering full support. (For a breakdown of current telehealth payment policies for each State’s Medicaid program seehttp://www.cchpca.org/sites/default/files/State%20Telehealth%20Laws%20and%20Reimbursement%20Policies.pdf)
- Health services provided to beneficiaries directly by federal and state agencies – Governmental agencies such as the U.S. Veterans Administration, Department of Defense, Indian Health Service, federal and state and local corrections departments are active providers of remote health care. This is rapidly expanding and increasingly relies on partnerships with non-governmental health providers.