Telehealth Use Limited in Some Federal Health Programs, GAO Finds

Telehealth and remote patient monitoring have the potential to boost access and quality of care for patients in federal health programs, especially if they live in remote areas. However, very few beneficiaries receive care this way, according to limited data reviewed by the Government Accountability Organization (GAO).

While barriers persist, the GAO report finds that could change as payment reform takes hold.

“While Medicare currently uses telehealth primarily in rural areas or regions designated as having a shortage of health professionals, in the future emerging payment and delivery models may change the extent to which telehealth and remote patient monitoring are available and used by Medicare beneficiaries and providers in other areas,” the report stated.

The GAO report, issued Friday, found that less than 1% of Medicare beneficiaries and about 12% of those who get healthcare through the Department of Veterans Affairs (VA) receive care through telehealth or remote patient monitoring, for reasons from a lack of available codes to Medicare rules for where care can take place.

Policies for telehealth vary:

• Medicare pays for 81 telehealth services. But CMS requires that when telehealth is used to give care to a patient in a remote area or one with physician shortages, it must take place at an “originating site,” such a doctor’s office, skilled nursing home, or rural health clinic.
• Medicaid, by contrast, gives states the last word on telehealth rules, which means its use varies by location.
• The Department of Defense (DOD) does not limit telehealth service for what the report calls its “direct care component.” The rule for originating sites allows those that the provider deems appropriate, including the patient’s home. DOD also does not limit use to rural or underserved locations.
• The VA also does not limit telehealth services or locations, and the healthcare provider for veterans has successfully used telehealth for one high priority: connecting veterans suffering from post-traumatic stress disorder with mental health providers.

So far, the Congressional Budget Office (CBO) has not pinned down what the cost would be to federal programs if telehealth took flight. Experts believe giving providers more flexibility to see patients remotely could improve the ability to monitor patients with chronic conditions or increase the availability of mental health care in areas with shortages of psychiatrists or counselors.

But, the report said, “the financial impact of expanding telehealth and remote patient monitoring in Medicare is difficult to predict—it may reduce federal spending if used in place of face-to-face visits, but it may increase federal spending if used in addition to these visits.”

Advocates for telehealth say the fears of overutilization and opposition from some physician groups have kept telehealth from achieving its potential. There are also some connectivity hurdles to overcome. But some experiences in Medicaid, a program that gives states the last work on telehealth rules, show the potential to reach hard-to-serve populations.

Mississippi, one of nation’s poorest states with high rates of diabetes and obesity, is a telehealth leader. The University of Mississippi Medical Center has produced early results that show remote monitoring of high-risk patients can improve health indicators and reduce trips to the emergency department or specialists.