Telehealth providers have been lobbying for years to be able to break into the Medicare market, but this year they might actually succeed.
Reuters reports that four different bills could make the difference, removing barriers that kept telehealth from being reimbursed by Medicare for "doctors' and medical visits, which often start over the phone."
Charging across state lines and charging for medical consultations that don't happen in person have been barred for Medicare, which doesn't recognize the latter as being the equivalent of a visit to a doctor. More progress has been seen by the telehealth industry in advancing its cause with private insurers trying to cut down on health care cost; telehealth has been pointing out how much cheaper such "visits" can be when driven by apps and mass smartphone usage.
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Still, the furthest along of the four bills is the telehealth-friendly CHRONIC Care Act, already approved by the Senate. It would promote home-based care and expand the remote treatment of stroke and dialysis patients.
It still remains to be seen, of course, whether any of the bills will pass, considering how divided Congress is on just about everything, but investors and large health care providers are on the sidelines, waiting to pounce once they see what happens next.
In the U.S., the dominant provider is Teladoc, Inc., which in 2016 was estimated to account for 75 percent of reported video or phone visits. However, the smaller and privately run American Well has already been the beneficiary of a commitment to the tune of $59 million from European insurance company Allianz Group.
Private insurers like analysts' claims that telehealth costs are at most a third of in-person care—particularly since those insurers cover the medical expenses of nearly 70 percent of U.S. adults aged 18–64. And according to an estimate from Cowen and Co analyst Charles Rhyee, telehealth calls can average between $40–$50, compared with urgent care visits' price tag of $150 and the nearly-ten-times-greater emergency room cost of close to $1,500.
In addition, Rhyee estimates that roughly $135 billion of Medicare's annual $675 billion in spending could be done by telehealth.
The battle to convince lawmakers could be made or broken by a report due by mid-March from MedPAC, the Medicare Payment Advisory Commission that advises Congress on Medicare payments. And not everyone is convinced that telehealth is the solution to high health care costs, with critics warning that once it's in place on a large scale, telehealth visits might end up supplementing, instead of substituting for, in-person doctor visits.
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