Telemedicine Reduces Rural Health Disparities, Says UnitedHealth

Increased use of telemedicine could help reduce the significant disparities between rural healthcare and the healthcare delivered in urban and suburban areas. That's the conclusion of a new report from a research center linked to UnitedHealth Group, one of the nation's largest private insurers.

Among the report's recommendations are:

-- Expand broadband connectivity to enable growth of telemedicine adoption;

-- Encourage physicians to incorporate telemedicine into their practices;

-- Reduce regulatory barriers to telemedicine use; and

-- Improve and align reimbursement approaches across payers to encourage greater use of telemedicine across rural settings.

UnitedHealthcare, UnitedHealth's insurance arm, covers telehealth visits, said company spokesman Daryl Richard. "We also intend to reach out to medical societies and accreditation agencies to better define, and structure reimbursement policies around, the appropriate use of the service in the home, at remote locations, and in physicians' offices."

According to the report, from the UnitedHealth Center for Health Reform and Modernization, payments to physicians for remote consultations are more prevalent than those for remote monitoring of patients.

But Jonathan Linkous, CEO of the American Telemedicine Association, noted that a growing number of health plans do pay for home monitoring of people with chronic diseases, such as congestive heart failure or diabetes, as well as those who have recently been discharged from the hospital.

In addition, he said, some commercial plans reimburse for teleconsults, such as videoconferences with specialists in a primary care doctor's office. "Some private payers will reimburse for stroke or for remote intensive care services. There is also coverage for some other specialty consults. It's growing rapidly."

Why are payers more willing to cover telemedicine these days? "The evidence base has been there for enough years so they can see what it means in terms of quality of care and cost of care," Linkous said. "If you don't need to have a specialist in every location, that's a cost saver because you can avoid having people go back in the hospital."

Medicare seems to cover a broader range of telehealth services than many private payers do. According to the report, the government program "provides reimbursement for remote services such as teleradiology; remote monitoring, such as cardiac and pacemaker monitoring; non-face-to-face services conducted through video clips or store-and-forward communication; home healthcare services; and consultations provided by skilled nursing facilities."

Linkous points out, however, that the private payers reimburse for telehealth services regardless of where patients live. In contrast, Medicare covers certain forms of telemedicine only in rural shortage areas.

For private payers, Linkous said, "it's not a rural issue. It's a matter of keeping those people out of the hospital and monitoring their health regardless of where they live."

Medicaid programs in about half of the states now reimburse for some types of telemedicine, he added. And a dozen states require private payers to cover it.

Up until now, Medicare has been selective about the telemedicine services it pays for, reserving coverage for those it deems to be equivalent to face-to-face services. But the Centers for Medicare and Medicaid Services recently proposed that it might begin using clinical benefit, rather than comparability, as the basis for coverage decisions related to telemedicine.

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