Zipnosis has a long history of engaging with stakeholders on telemedicine regulation at both the state and Federal level. In July, the Centers for Medicare and Medicaid Services (CMS) released the proposed 2019 physician fee schedule (PFS) rule. Among other things the proposed rule opens the door for greater, more consistent physician reimbursement for care delivered via telemedicine technology.
On September 4, Zipnosis submitted comments to the CMS in response to this rule change, which we see as the first step toward achieving something we have long advocated for – reimbursement parity for care delivered via virtual care. It is heartening to see the CMS using the PFS changes for 2019 as a vehicle to improve reimbursement and hopefully to create momentum for the much needed comprehensive updates to the Medicare telemedicine rules.
While there is much to like in the proposal, we highlighted 3 substantive concerns:
Inclusion of telephone calls as a Brief Communication Technology-Based Service:
While phone consultations may be a valuable tool for patients with an existing provider relationship, 37 state medical boards have explicitly stated that a phone call is insufficient to establish a physician/patient relationship and does not meet the standard of care.
Reimbursement levels for care delivered remotely:
Virtual care and telemedicine can produce marked efficiencies in care delivery; however, these technologies have additional associated costs that need to be considered. Additionally, the physician documentation requirements for care delivered remotely are the same as for a brief office visit. As such, reimbursement for these visits should be substantively similar to that of in-person care. The very low reimbursement proposed is not sufficient to drive increased technology use.
Diagnosis and treatment of new patients:
The proposed rule would allow for use of Brief Technology-Based Services to establish the provider/patient relationship in some instances. Many Medicare beneficiaries have pre-existing conditions and co-morbidities that make straightforward diagnosis and treatment challenging without some longitudinal knowledge. To safely and effectively care for these patients remotely, these services should only be delivered in the context of an existing physician/patient relationship.