Telemedicine – ScriptSourcing

More Providers Charge for Telemedicine, Phone Visits and Doctor E-Mails

More hospitals and insurers have started charging patients for virtual care services as they have grown in usage and providers are spending more time meeting patients in telehealth appointments and responding to their e-mails.

Many hospital systems have started billing patients for e-mails they send to their physicians and, depending on the level of out-of-pocket expenses in their plan, they may pay just a few dollars for a copay or up to $100 if they have a high deductible.

With these forms of communication growing in use, employers may want to remind their employees to look at their plans’ benefits summaries to see how much they will have to pay for these services.

The hospitals argue that physicians spend a significant amount of time responding to inquiries and it takes just as much time for them to conduct telemedicine and phone appointments as it does in-person visits.

A short five-minute session with a patient on a phone or video appointment will typically result in associated work, including reviewing the patient’s chart, updating notes and putting in orders for medications, tests or referrals.

Billing under insurance

The Centers for Medicare and Medicaid Services introduced Medicare billing codes for telemedicine in 2019, paving the way for providers to allow patients to seek reimbursement for messages their doctors send them using an electronic portal.

Under the rules, a provider can bill for a message only if it’s in response to a patient inquiry and requires at least five minutes of the doctor’s time.

Many of the country’s health insurers have followed Medicare’s lead, reimbursing hospitals for doctors’ e-mails. In turn, insurers may charge patients a copay or they may have to pay for the service fully if they have a deductible they must first meet. Even then, fees for these types of appointments are typically lower than for in-person visits.

It should be noted that there may not be fees associated with some services such as asking a doctor for a prescription refill or follow-up care.

How it’s being billed

The amount that patients are being billed varies among hospital systems and insurers.

According to recent surveys, out-of-pocket telemedicine visits are an average of $30-75 nationally, with most visits at around $40-50. According to Becker’s Hospital Review:

Medicare pays around $50 per televisit on average.
Mayo Clinic started charging $50 for some online emails written by its doctors after a surge in mail volume.
Humana’s health plan On Hand charges $0 to $5 per visit.
Walmart offers its employees $4 telehealth appointments.
SSM Health, a hospital system in St. Louis, charges $25.
Summa Health, a hospital system in Akron, Ohio, charges $30.

The takeaway

Hospitals and providers are all charging different amounts for televisits, phone visits and their doctors sending e-mails. As well, insurers have different cost-sharing structures for their enrollees.

It’s important that you warn your employees to read plan summaries of these costs if they are regular users of these services, as health plan coverage will vary depending on deductible and copay levels. Doing this can help them avoid surprise bills, particularly if they have grown used to paying nothing for such services.

Virtual-First Health Care Plans Flooding the Market

In the continuing quest to reduce health care costs and make care more accessible, a new type of health plan has been taking shape: The virtual-first health plan.

These rapidly evolving plans integrate virtual care delivery models into a comprehensive health plan that encourages enrollees to access virtual care with their doctors before resorting to an in-person visit.

These plans are coming to market as Americans have gotten use to virtual visits with their doctors during the last three years of the COVID-19 pandemic and virtual care becomes more common even in traditional health plans.

While the uptake is still quite small — 6% of employers surveyed in 2022 offered these plans — it’s expected to grow quickly over the next few years.

All of the major health insurers in the U.S. have already announced various tie-ups with virtual care providers and tech vendors to improve their telemedicine offerings, and the uptake will continue growing as employers and their workers grow more comfortable with the plans.

A recent survey by Mercer found that, among organizations with 500 or more employees:

52% plan to offer virtual behavioral health care in 2023.
40% plan to offer a virtual primary care physician network or service in 2023.
21% already offer virtual specialty care, like for dermatology, diabetes or musculoskeletal issues.

There are a number of benefits to virtual-first primary care:

Easier access — Virtual care is ideal for people with health problems that make it difficult to see their doctor or who do not live near a hospital or doctor’s office.
Reduced costs — Telemedicine visits cost less than in-person visits, and they can yield additional savings through technological efficiencies.
Convenience — Enrollees don’t have to drive to the doctor’s office, contend with traffic or sit in the waiting room — and they can meet with their doctor from the comfort of their home.
Better health outcomes — Virtual first plans will often put a premium on health records integration across the care spectrum to ensure that care team members have access to them, which can help them provide better clinical and administrative support.

How they work

Virtual-first health plans include the same coverage as traditional health plans, including fee-for-service, health maintenance organizations and preferred provider organizations, but they focus on directing enrollees to telemedicine options for their doctor’s visits.

The key difference is that they aim to significantly reduce costs by incentivizing enrollees to seek out virtual care first through plan design, incentives and advocacy. Consultation sessions can often be performed virtually, saving both the patient and doctor time, while reducing the costs for each visit.

Virtual-first plans incorporate the same arrangements as traditional health plans, except that most doctor’s visits will be online, or via a smartphone app. When a patient needs to see their doctor, they’ll schedule the visit on their account — and they’ll need to opt out of a virtual visit if they feel that they need to see the doctor in person.

Additionally, if possible, specialist visits can also be conducted on the app or website.

The takeaway

Virtual-first care plans are an evolving product and it’s important to find a plan that can truly save you money while not sacrificing quality of care.

These plans are still in their infancy and are hitting the market in increasing numbers. But because they are new, there is no uniform standard for them. The most important aspects to look for in these plans are strong member engagement and seamless integration to ensure quality of care.

Give us a call if you’re curious about these plans, to find out if carriers in the area are offering them and, importantly, whether they are a good fit for your organization.

Employers Focus on Cost Containment, Mental Health and Telemedicine

A new survey has found that managing health care costs and expanding mental health benefits will be a top priority for U.S. employers as they ramp up benefits to compete for talent in the tight job market spawned by the COVID-19 pandemic.

Additionally, virtual care is expected to become an essential and long-lasting feature of employers’ health insurance and employee benefits strategies over the next few years, according to the “2022 Emerging Trends in Healthcare Survey” by Wills Towers Watson.

The focus on health care and insurance costs, mental health and expanded telehealth comes as employers continue pulling out all the stops to compete in a tight job market but face health care inflation headwinds.

Here’s the direction many employers are going, according to the survey.

Dealing with rising costs

In light of continuing rising health insurance costs, 94% of employers surveyed said they are redoubling their efforts to make benefits more affordable for their workers.

Nearly two-thirds of employers (64%) said they will take steps to address employee health care affordability over the next two years. Steps they are considering include:

Improving quality and outcomes to lower overall cost.
Adding or enhancing low- or no-cost coverage for certain benefits.
Making changes to their employees’ out-of-pocket costs.
Increasing the amount they contribute towards their employees’ health insurance premium.

Employers also felt that many of their employees were not getting the most out of their benefits and needed further education on all of their offerings. More than half (54%) said that lack of employee awareness about where to find programs to support their needs was a significant challenge.

Mental health

Eighty-seven percent of employers said that enhancing mental health benefits will be a priority for them.

That’s in response to numerous studies and reports indicating that the COVID-19 pandemic has spurred a mental health crisis.

Another poll — the “Workforce Attitudes Toward Mental Health” report — by Headspace Health illustrates the depths of the problem:

83% of CEOs and 70% of employees report missing at least one day of work because of stress, burnout and mental health challenges.
Only 28% of employees report feeling “very engaged” in their work.
Top global stressors for employees are COVID-19; burnout because of increased workload or lack of staff; poor work-life balance; and poor management and leadership.
40% of women and 33% of men surveyed said they feel burned out at work.
Remote workers are feeling increasingly isolated.

In response to this, 66% of employers surveyed by Willis Towers Watson said that ensuring that their health and well-being programs support remote workers will be a key priority of their strategy over the next two years. More than six in 10 employers plan to enhance programs and well-being activities to focus on health issues of their employees’ family members.

Virtual care

Use of virtual care — or telemedicine — has exploded during the pandemic, particularly in 2020 and 2021, when many people were afraid to go to the doctor in person for fear of contracting COVID-19.

Additionally, many health care providers pushed virtual care to avoid having too many people come to medical facilities that were burdened by an avalanche of patients.

Congress passed laws allowing health insurers to cover telemedicine as they would other visits to a doctor. And now telemedicine is poised to be a permanent fixture of employers’ health care strategies.

Willis Towers Watson found that by the end of 2023:

95% of employers expect to offer virtual care for medical and behavioral health issues,
61% of employers expect to offer lower cost-sharing for virtual care,
53% of employers expect the expansion of telemedicine to help decrease costs in the long run, and
50% believe virtual care will improve health outcomes for their employees.

Fortunately for employers, a number of companies have cropped up during the last few years that focus on delivering state-of-the art telemedicine platforms.

The takeaway

The pandemic has spurred many employers to prioritize their employees’ well-being, as well as look for ways to manage costs.

With competition for employees fierce, many employers are focused on reducing their staff’s share of costs, while also expanding mental health services in response to growing demand.

Meanwhile, telemedicine services are still evolving, a trend that’s likely to continue for the foreseeable future as health care providers, insurers and employers see it as a way to rein in some costs.

Push to Expand Telemedicine Parity Continues

Telemedicine got a big boost during the COVID-19 pandemic, and now a number of states have been moving to ensure that health plan enrollees still have access to it and pay for it just as they would in-person visits.

During the pandemic, insurers agreed to pay for virtual visits just as they would for a face-to-face appointment, doctors who had been reluctant to try new technology embraced it as a way to limit patient exposure, and lawmakers loosened federal regulations that for years had restricted telemedicine’s use.

But more than two years into a public health emergency, some health insurers have begun to roll back their pandemic-era coverage policies or fallen into a pattern of extending coverage for only a few months at a time. There are now efforts in a number of states to require that health insurers cover telemedicine visits the same as face-to-face ones.

Thirty-one states mandate both coverage parity and payment parity. The language of the payment parity mandates differs by state. In eight of them, the mandated payment applies only to the deductibles, copayments and coinsurance faced by the insured. For example, in Texas, coinsurance, copayments and deductibles for telemedicine “may not exceed” those for the same service provided in person.

Other states mandate parity in how insurance plans reimburse providers. For example, in Arkansas and California, reimbursement for health care services provided via telemedicine must be “on the same basis as in-person services.”

Telemedicine improves outcomes, saves money

Recent studies have shown that telemedicine can yield significant savings for group health plans and covered employees — but only if the employees actually use it.

The main thrust of telemedicine is to give workers the option to talk to a health care provider over the phone or by video link about a health issue they may be having. Maybe waiting for an appointment slot to open with their doctor would take too long, or perhaps driving to the doctor’s office may be unfeasible for whatever reason.

Experts say that allowing health plans to charge for telemedicine visits the same as they do for in-person visits can reduce the likelihood that an illness is left untreated, which increases treatment costs in the end, especially if they have to go to the emergency room for treatment.

Telemedicine benefits

Convenience — For many people it’s hard to take time out of the day to go to the doctor, particularly in areas where access to care is limited. For non-serious cases, telemedicine is a good option. If the physician or nurse feels that symptoms are serious, they can always ask the covered individual to come in for an appointment.

Cost savings — Just by its nature, telemedicine can save money, particularly for individuals who habitually go to ER or urgent care for routine services. Telemedicine can be marketed to employees as a much less expensive alternative for after-hours care.

Managing chronic illness — Telemedicine is ideal for workers with chronic conditions who may have a hard time getting to regular doctors’ appointments. Technology exists that can transmit health data from a patient’s home to a doctor’s office.

Addressing concerns

Many people are uneasy about working with a provider over a video link if they have had no prior patient relationship with them.

You can address these concerns by:

Highlighting credentials of doctors in the telemedicine network.
Working with us or your health insurer to try to change plan designs in order to eliminate copays for telemedicine.
Setting aside a room at your offices where your staff can access telehealth services, particularly if they have chronic conditions that may need monitoring on a regular basis.
Choosing the right vendor, which is crucial. Evaluate vendors based on patient satisfaction, the quality of the providers and the breadth of specialties available.

Telemedicine Taking Off, Reducing Health Costs

One of the fastest growing parts of the health care system, and which touches significantly on group health plans, is telemedicine.

From 2016 to 2017, insurance claims for services rendered via telehealth ― as a percentage of all medical claim lines ― grew 53% nationally, faster than any other avenue of care, according to “FH Health Indicators,” a white paper published by the nonprofit FAIR Health.

Telehealth uses technology to provide remote care via video conferencing and other means and is proving to be more and more effective, especially for time-pressed individuals or people who live in rural areas where patients often have to travel great distances for care.

Elderly patients especially find it useful, since it eliminates the need for transportation.

But as telehealth gains traction, the focus is shifting away from the novelty of connected devices and new technology and more toward providing patients with top-notch care ― and giving providers, physicians and nurses alike the power to deliver it effectively. As it evolves, it is also a promising new trend in terms of reducing health care delivery costs.

Telehealth can reduce the cost of care by eliminating the physical barriers that prevent patients from managing their health. As more patients take advantage of digital services like remote patient monitoring, automatic appointment reminders, and remote physician consulting using live video and audio, patients can use these services to reduce the cost of care and improve their chances of early detection.

And that can reduce your overall group health plan costs, as well as out-of-pocket costs for your employees.

Tech firms are coming up with more efficient ways for patients to communicate with their doctors that save time and money, and reduce liability for doctors as well. For example, more and more health care practitioners are adopting an online patient portal as a direct link between the patient and the doctor.

Doctors, patients embrace online portals

The portal can easily be password-protected for each patient and streamline routine interactions from appointment-setting to refilling prescriptions ― and everything in between.

For example, when it’s time to get a prescription refilled, the patient simply makes a request to his or her doctor, via the patient portal or even via a cell phone or tablet app that can be proprietary to the practice. The doctor checks the dosage and approves the request in a few clicks, and in seconds the information is sent directly to a pharmacy so the patient can pick up the prescription.

The patient doesn’t have to get the doctor on the phone or bug the staff for a moment with the doctor, and the doctor doesn’t have to do additional paperwork or get on the phone with the pharmacy to call in the prescription after already having spoken with the patient on a separate call. The result is tremendous time savings ― and ultimately, cost savings for both the doctor and patient.

Online portals also facilitate communication between doctors and patients between appointments. If a patient has a question or clarification that does not warrant an additional office visit, the doctor or staff can quickly respond in an instant, without playing phone tag, and without having to route calls to busy doctors who can’t always be on the phone.

Physicians can also leverage these portal technologies to send lab results and images directly to the patient using a secured and encrypted link, and to make clinical summaries easily available online. When the doctor adds new information to the file, such as a lab report, the portal system can be programmed to automatically send an e-mail alert to prompt the patient to log onto the portal.

For all the technology though, we still have a way to go in implementing it. According to a recent study in the Journal of General Internal Medicine, 57% of respondents said they want to use their doctor’s website to review their medical records, but only 7% of those polled reported having made use of that technology to access their own information online.

A study from the Annals of Internal Medicine found that 77% to 87% of individuals who used their physician’s portal to open at least one note, and who completed a post-intervention survey, said that the process helped them be more in control of their health care.