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HLCCompendium
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NDHI<br />
NAT IONAL DIALOGUE FOR<br />
Healthcare Innovation<br />
Inclusion of Telemedicine in<br />
Medicare<br />
Organization Overview<br />
• Teladoc is the first and largest provider of telehealth<br />
medical visits in the United States, with 15.4 million<br />
members and over 1.6 million visits since the organization’s<br />
inception in 2002<br />
• The company was founded with a vision to tackle<br />
three of the most significant issues in healthcare<br />
today: access, cost, and quality of care<br />
• Teladoc provides patients access to a nationwide<br />
network of board-certified physicians<br />
Background<br />
CMS’s current telemedicine reimbursement regulations<br />
indicate that a patient must seek care at one of eight<br />
kinds of facilities outside of a Metropolitan Statistical<br />
Area (MSA), in order for telemedicine services to<br />
be reimbursed: a physician’s office, hospital, critical<br />
access hospital, rural health clinic, federally-qualified<br />
health center, skilled nursing facility, community mental<br />
health center, or a hospital-based or critical access<br />
hospital-based dialysis facility. This usage restriction<br />
is a result of concerns from the Congressional Budget<br />
Office, CMS, and other groups, which believe that coverage<br />
of telemedicine services will lead to inappropriate<br />
utilization, increased government budget costs, and<br />
reduced quality of care.<br />
However, Teladoc rejects this hypothesis, as it lacks a<br />
basis of empirical evidence. On the contrary, Teladoc<br />
believes that CMS’s standpoint perpetuates outdated<br />
protocols created before innovations in telemedicine<br />
and the emergence of current technologies. In contrast<br />
to CMS’s limited use of this technology, telemedicine is<br />
not only used more widely by the commercial market<br />
and employer sector, but is also experiencing a sharp<br />
growth trajectory at the national level.<br />
Initiative Details<br />
Teladoc advocates for CMS to either allow telemedicine<br />
to be reimbursed, or to allow for a pilot study to<br />
demonstrate its associated cost savings. Specifically,<br />
Teladoc aims to expand telemedicine reimbursement<br />
for simple, non-emergent illnesses, as well as dermatology<br />
and behavioral health, while the patient is at<br />
home or at a site that is not currently included in the<br />
CMS regulations.<br />
Partners in this effort include the Alliance for Connected<br />
Care, Health IT Now and the American Telemedicine<br />
Association.<br />
An Initiative of the<br />
107 |<br />
Inclusion of Telemedicine in Medicare