Thursday, December 17, 2015

Reducing Disparities and Improving Outcomes with Interactive Games

What are Health and Health Care Disparities?
Health disparity: A higher burden of illness, injury, disability, or mortality experienced by one population group relative to another group.
Health care disparity: Differences between groups in health insurance coverage, access to and use of care, and quality of care.

Why do Health and Health Care Disparities Matter?
Disparities in health and health care limit continued improvement in overall quality of care and population health and result in unnecessary costs. 
  • Addressing disparities in health and health care is not only important from a social justice standpoint, but also for improving the health of all Americans by achieving improvements in overall quality of care and population health. Moreover, health disparities are costly, resulting in added health care costs, lost work productivity, and premature death. 

    Recent analysis estimates that 30% of direct medical costs for Blacks, Hispanics, and Asian Americans are excess costs due to health inequities (Figure 1) and that, overall, the economy loses an estimated $309 billion per year due to the direct and indirect costs of disparities.

Figure 1: Excess Medical Expenditures Due to Health Inequities

What is Needed to Reduce Disparities?

To reduce health disparities, interventions are required that can be used again and again without losing their therapeutic power, that can reach people even if local health care systems do not provide them with needed health care, and that can be shared globally without taking resources away from the populations where the interventions were developed. 

Reducing Disparities with Interactive Games
Presenting information to patients and caregivers in the form of an interactive game reduces anxiety and improves engagement. 
Click either of the pictures below  to see how games can be used to improve screening rates.

Visit mHealth Games for more information....

Thursday, October 22, 2015

Medicare RACs Identified Almost $2.4 Billion in Overpayments in FY 2014

According to CMS, the Medicare Fee-For-Service (FFS) Recovery Auditor Program identified and corrected $2.57 billion in improper Medicare payments in FY 2014. The lion’s share of this amount — $2.39 billion — represented overpayments collected, compared to $173.1 million in underpayments repaid to providers. Considering all program costs (other than expenses incurred at the third and fourth levels of appeal), CMS concluded that the Medicare FFS Recovery Audit Program returned more than $1.6 billion to the Medicare Trust Funds. Note that the overall level of FY 2014 recoveries was down from FY 2013 levels, when Recovery Audit Contractors (RACs) identified $3.75 billion in improper payments. CMS attributes some of this decrease in RAC identification of improper payments to a prohibition on certain RAC inpatient hospital patient status reviews, along with reduced reviews during the close-out process of existing RAC contracts.

Saturday, October 17, 2015

HHS-HCC Risk Adjustment Review

Open Enrollment starts November 1st.... Is your team ready?

Test your risk adjustment knowledge with this new game from mHealth Games.  Click the picture above to launch.

Quick Review of the ACA Commercial Model of Risk Adjustment, and HHS-HCC Codes in ICD-10.

Early Detection Saves Lives

The American Cancer Society estimates that 526 women in the US will be diagnosed with breast cancer today.
Add that up and that’s 192,200 women in the US diagnosed every year. What are the odds that one of them is someone you know?
If we are all doing our monthly self-exams and remembering to schedule a mammogram, the odds of surviving a fight with breast cancer increases greatly.

Why are self-exams so important?

Self-exams are an important first step because you can often feel a lump before it has caused any other symptoms. When was your last breast self-exam?

Click the picture above to play “Now Showing” and become a BSE expert!

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Tuesday, October 13, 2015

Computerized cognitive training improves childhood cancer survivors' attention and memory

Intensive, adaptive computer-based cognitive training presented as a video game helped improve working memory and other cognitive skills of childhood cancer survivors and holds hope for revolutionizing management of the late effects of cancer treatment. St. Jude Children's Research Hospital investigators led the study, which appears in the Journal of Clinical Oncology.
Working memory improved significantly, and attention and processing speed also improved for childhood cancer survivors who completed between 20 and 30 computer-based training sessions. Processing speed measures the speed at which the brain processes information. The sessions lasted 30 to 45 minutes and included verbal and visual-spatial exercises presented as games but designed to improve working memory.
The benefits to working memory and attention from the training were comparable to gains reported in previous studies of stimulant medications. The gains from cognitive training moved performance of the 30 survivors who completed the training into the normal range. Caregivers also reported significant improvement in the attention and executive functioning of survivors who completed the training compared to a similar group of survivors who had not. Executive functioning includes skills like planning and focus needed to juggle multiple tasks and get things done.
Changes in brain activity during brain imaging suggest the intervention might capitalize on neuroplasticity to train the brain to work more efficiently.
"These results suggest that computerized cognitive training may help fill a void in management of cognitive late effects that impact quality of life for childhood cancer survivors, such as the likelihood they will complete school and live independently," said first and corresponding author Heather Conklin, Ph.D., an associate member of the St. Jude Department of Psychology. "While medication and therapist-led interventions have shown some benefit for select survivors, online training marks a significant advance by giving survivors convenient access to an effective intervention."
Previous research from other investigators showed that individuals with developmental and acquired attention disorders benefited from intensive computer-based cognitive training using repetitive exercises of graded difficulty. This study used a commercially available program called Cogmed and is the largest yet involving cancer survivors. Currently, such programs are not covered by insurance.
This study included 68 childhood cancer survivors who had received cranial irradiation, intrathecal chemotherapy or both for treatment of acute lymphoblastic leukemia (ALL) or brain tumors. Intrathecal chemotherapy involves delivering anti-cancer drugs directly into the cerebrospinal fluid surrounding the brain and spine. The therapies leave survivors at an increased risk for cognitive declines that reduce academic, social and work-related achievement.
Study participants were 8 to 16 years old and had completed treatment and been disease-free for at least one year. Prior to joining the study, all scored below expectations on measures of working memory.
Half the participants were randomly assigned to begin the intervention immediately. The remaining survivors were offered the intervention about six months later. The training included weekly coaching by telephone for survivors and families.
Survivors who began training immediately also underwent functional MRI brain imaging before and soon after completing the intervention. The imaging tracked brain activity as the survivors completed a working memory exercise. Post-intervention imaging showed survivors decreased activity in specific prefrontal regions, which suggests their brains may be working more efficiently.
"That suggests the intervention exercised and strengthened the well-established working memory network. The implication is that the brain may operate more efficiently and have less need for compensatory strategies," Conklin said. "Such training-induced neuroplasticity suggests the benefits might be sustained going forward."
Researchers are now studying the possible benefits of starting brain training during treatment or combining it with other interventions. Investigators are also tracking whether the cognitive benefits are sustained and translate into the improved academic performance reported for other populations. In this study, gains in working memory, attention and processing speed did not translate into improved math or reading performance.
Conklin said that overall the results are good news for the nation's growing population of childhood cancer survivors, now estimated to include more than 420,000 individuals. "Computerized cognitive training is a more feasible, portable and efficient intervention than we've had in the past and is likely to result in meaningful improvement in the cognitive problems survivors experience," she said.

Monday, September 28, 2015

3 New Games for Your Health Literacy Toolbox!

Click on any of the games below to launch:

COPD Bowling League

Although there is no cure for COPD, there are things you can do to control your symptoms and improve your quality of life. Join the Wednesday night Bowling league to learn how to take control of COPD. Learning how to strike out an exacerbation will ultimately lead to a winning season.

How many steps will it take to walk off these fast food favorites?

Carbohydrates are an important part of a healthy diet, but there's much discussion about the good and bad carbs. So how do you know which is which? The answer is both simple and complex!

Visit mHealth Games or email to learn more...

Thursday, September 24, 2015

ICD-10: One Week Out

By Dr. Bill Rogers, ICD-10 Ombudsman

In one week, the U.S. health care system will start using the International Classification of Diseases, 10th Revision. This is a huge moment because ICD-10 will help doctors and other health care providers better:
  • Define patients’ clinical status and treat their complex medical conditions.
  • Coordinate care among providers.
  • Support new payment methods that drive quality of care.
As we come to October 1st, CMS wants to assure the medical community that we’ve tested and retested our systems, and we’re prepared to solve problems that may come up.
Because we know this is a major transition, we’ll be:
  • Monitoring the transition in real time.
  • Watching our systems.
  • Addressing any issues that come to the ICD-10 Coordination Center.
We’ll also be supporting you in four ways:
  1. If you need general ICD-10 information, we have many free resources at our Road to 10 webpage and on gov/ICD10 that can help, such as the ICD-10 quick start guide, customized ICD-10 action plans, videos, and Frequently Asked Questions.
  1. Your first line for help for Medicare claims questions is to contact your Medicare Administrative Contractor. They’ll offer their regular customer service support and respond quickly. You can find MAC contact information here.
  1. You can e-mail our ICD-10 Coordination Center, and we’ll respond to your questions.
  1. You can contact me, the ICD-10 Ombudsman. I’ll be an impartial advocate for providers, focused on understanding and resolving your concerns.
We’ve been working to help you move to ICD-10 by offering resources and flexibility, but if you aren’t ready for the transition, you still have options that will enable you to continue to provide care and be paid for your services. We recommend that you check with other payers to learn about their available claims submission alternatives.
The Road to 10 countdown clock highlights how close we are to this important milestone. If you haven’t yet started to transition, it is doable, and we encourage you to start today.

Friday, September 18, 2015

Patient Engagement Advisory Committee


The Committee will provide advice to the Commissioner or designee, on complex issues relating to medical devices, the regulation of devices, and their use by patients. The Committee may consider topics such as: Agency guidance and policies, clinical trial or registry design, patient preference study design, benefit-risk determinations, device labeling, unmet clinical needs, available alternatives, patient reported outcomes and device-related quality of life or health status issues, and other patient-related topics. The Committee will provide relevant skills and perspectives, in order to improve communication of benefits, risks, clinical outcomes, and increase integration of patient perspectives into the regulatory process for medical devices. It will perform its duties by discussing and providing advice and recommendation in ways such as: Identifying new approaches, promoting innovation, recognizing unforeseen risks or barriers, and identifying unintended consequences that could result from FDA policy.

Committee Membership

The Committee will consist of a core of nine voting members, including the Chair. Members and the Chair are selected by the Commissioner or designee from experts who are knowledgeable in areas such as clinical research, primary care patient experience, and health care needs of patient groups in the United States. Selected Committee members may also be experienced in the work of patient and health professional organizations; methodologies for eliciting patient preferences; and strategies for communicating benefits, risks and clinical outcomes to patients and research subjects. Members will be invited to serve for overlapping terms of up to 4 years. Almost all non-Federal members of this committee serve as Special Government Employees. The voting members may include one consumer representative who is a technically qualified member, selected by the Commissioner or designee, identified with consumer interests, and is recommended by either a consortium of consumer oriented organizations or other interested persons. The Commissioner or designee will also have the authority to select from a group of individuals nominated by industry to serve temporarily as non-voting members who are identified with industry interests. The number of temporary non-voting members selected for a particular meeting will depend on the meeting topic.

Contact Information

Letise Williams, Designated Federal Official
Office of Center Director
Center for Devices and Radiological Health
Food and Drug Administration
10903 New Hampshire Ave.
Silver Spring, MD 20993
Phone: 301-796-8398

FDA Advisory Committee Information Line

(301-443-0572 in the Washington, DC, area)
Please call the Information Line for up-to-date information on meetings

Friday, July 10, 2015

Federal Audits Of Medicare Advantage Reveal Widespread Overcharges

Laughing Stock/Corbis

Government audits just released as the result of a lawsuit detail widespread billing errors in private Medicare Advantage health plans going back years, including overpayments of thousands of dollars a year for some patients.
Since 2004, private insurers that run Medicare Advantage plans, an increasingly popular alternative to traditional Medicare, have been paid using a risk scorecalculated for each patient who joins. Medicare expects to pay higher rates for sicker people and less for those in good health.
But the internal audits, never before made public, provide striking new evidence of billing mistakes — mostly overcharges — in the Medicare Advantage plans. Four of the audits were recently obtained by the Center for Public Integrity through a court orderin a Freedom of Information Act lawsuit.
The audits involve four health plans: an Aetna Health Inc. plan in New Jersey, Independence Blue Cross in the Philadelphia area; Lovelace Health Plan in Albuquerque, N.M, and a Care Plus plan in South Florida. Care Plus is a division of Humana, Inc.
Last month, the Center for Public Integrity reported on a fifth such audit at PacifiCare in Washington state, an arm of giant UnitedHealth Group, the nation's largest Medicare Advantage operator.
In all five audits, two sets of auditors inspected medical records for a sample of 201 patients at each plan for 2007. If the medical chart didn't document that a patient had the illnesses the plan reported, Medicare asked for a refund. Auditors also gave plans credit for underpayments they discovered.
Among the findings:
  • Medicare paid the wrong amount for 654 of the 1,005 patients in the sample, an error rate of nearly two-thirds. The payments were too high for 579 patients and too low for 75 of them. The total payment error topped $3.3 million in the sample.
  • Auditors concluded that risk scores were too high for more than 800 of the 1,005 patients, which in many cases, but not all, led to hefty overpayments. Medicare's annual payment for more than 200 patients was at least $5,000 higher than merited, according to the audits.
  • Auditors could not confirm one-third of the 3,950 medical conditions the health plans reported, mostly because records lacked "sufficient documentation of a diagnosis." The names of the medical conditions were redacted by federal officials.
The federal Centers for Medicare and Medicaid Services, or CMS, which conducted the audits, had no comment.
None of the health plans would discuss the audit findings. Aetna, in a statement, said the company had "raised a number of questions and concerns" regarding the results and was "awaiting a response from CMS."
Clare Krusing, a spokeswoman for America's Health Insurance Plans, the insurance industry's primary trade group, said the audits "overstated" the payment errors. Health plans have since improved their record keeping and offer better care for people with chronic health conditions than traditional Medicare, Krusing said.
"The evidence is overwhelmingly clear that these programs (Medicare Advantage) deliver the right care for beneficiaries," she said.
The records are coming to light at a time of rapid expansion — and consolidation — in the Medicare Advantage market. Enrollment has neared 17 million, about 1 in 3 people eligible for Medicare. Last week, Aetna announced plans to buy competitor Humana for $37 billion.
But the industry also is drawing scrutiny over the accuracy of risk-based payments—and a penchant for secrecy.
The Center for Public Integrity first reported last year that billions of tax dollars are wasted every year due to plans that appear to exaggerate how sick their patients are, a practice known as "upcoding."
The government audits, known as Risk Adjustment Data Validation, or RADV, are the government's primary tool for catching these sorts of billing mistakes and holding the industry accountable.
Yet the process has proven unwieldly at best, partly due to a complex and lengthy appeals process and partly to indecision over how much the health plans should refund to the government.
It's not clear how the five audits were settled because CMS officials have refused to release these records.
The five RADV audits were launched in 2008, but findings weren't issued until August 2012, when CMS officials sent each plan a form letter detailing the amount of the overpayment and the plan's extensive appeal rights. CMS has refused to make public the status of the audits—or even how many total RADV audits have been conducted. CMS cites an exemption to the Freedom of Information Act that shields "trade secrets."
This stance has largely concealed Medicare Advantage billing records. It wasn't until April 15, 2011, that CMS announced it would release minimal billing data annually. Doing so would "inform the public on how their tax dollars are being spent," the agency said at the time, citing President Obama's January 2009 Memo on Transparency and Open Government.
But much to the chagrin of some researchers, CMS has never expanded on what is released, even though it has made public a huge cache of billing data and audits centering on thousands of doctors, hospitals and other medical suppliers.
"It's astonishing," said Brian Biles, a professor at George Washington University who successfully sued CMS to win release of the limited billing data now available. "They are dumping huge amounts of data in other areas. Medicare Advantage is now 30 percent of the Medicare program." (Biles assisted the Center for Public Integrity with its 2014 analysis of that data.
Timothy Layton, a Harvard Medical School researcher who recently co-authored a paper on health plan upcoding, said scholars "are definitely hindered" by the lack of data. For instance, researchers can't examine individual risk scores and the various medical conditions that raise and lower them, he said.
"Without the ability to answer these questions, we can keep pointing out how big the overpayment to MA (Medicare Advantage) is, but we can never really provide the optimal solution to the problem," Layton said.
David Himmelstein, a physician and professor in the CUNY School of Public Health at Hunter College who supports a single payer medical system, agreed.
"Medicare publishes detailed data on almost every doctor and hospital that gets paid a penny, but it leaves the public — and researchers — almost completely in the dark about the giant Medicare Advantage plans that will collect more than $150 billion from Medicare this year," he said.
Still, Medicare Advantage insurers are facing calls for closer scrutiny of their operations. In May, Senate Judiciary Committee Chairman Charles Grassley, R- Iowa,wrote to Attorney General Loretta Lynch and CMS administrator Andrew Slavitt asking how many risk score fraud investigations had been conducted over the past five years and their results. He's still waiting for an answer.
"Sen. Grassley continues to expect responses to his letters and will continue to press for responses," said Grassley spokeswoman Jill Gerber. "This is an important issue involving a large amount of taxpayer money"
In a separate letter, Sen. Clare McCaskill, the senior Democrat on the Senate Aging Committee, asked CMS officials to advise her of government efforts to curb Medicare Advantage billing abuses.
"After meeting with CMS we have continued concerns about the level of oversight taking place with respect to Medicare Advantage plans and will continue working to increase oversight and accountability in this area," said McCaskill spokesman Drew Pusateri.
This piece comes from the Center for Public Integrity, a nonpartisan, nonprofit investigative news organization.

Tuesday, July 7, 2015

CMS: No ICD-10 Audit Claims for Specificity in Year One

For one year after implementation of ICD-10, CMS will not deny or audit claims just for specificity, as long as the code is from the appropriate family of ICD-10 codes. Similarly, physicians will not be penalized for the value-based payment modifier or Meaningful Use due to specificity of diagnoses.

After a vigorous, last-ditch push by the AMA for a two-year transition period after implementation to protect physicians from all ICD-CM coding errors and mistakes, CMS and AMA made a joint announcement that appears to signal a burying of the hatchet.

Steven Stack, MD, AMA's president, touts the changes in a post that begins with a concession his group has resisted stating for years: "Implementation of the ICD-10 code set is just around the corner, with a hard deadline of Oct. 1."

To gain that admission from the AMA, CMS agreed to a variety of policies involving claim denials, quality reporting, payment disruptions, and navigating the transition.

For one year after implementation, CMS will not deny or audit claims just for specificity, as long as the code is from the appropriate family of ICD-10 codes.  Even though the use of unspecified codes is allowed according to the ICD-10-CM Official Guidelines for Coding and Reporting, this clarification makes a lot more sense than absolving physicians of all coding errors and mistakes.

Similarly, CMS will not penalize physicians for the Physician Quality Reporting System, the value-based payment modifier, or meaningful use to due specificity of diagnoses as long as the provider reports a code from the appropriate family.

CMS has also authorized advance payments to physicians if Medicare contractors can't process claims due to problems related to ICD-10.

CMS will continue to offer resources to aid practices with a new ICD-10 communications and coordination center headed by an ombudsman to resolve outstanding questions about implementation.
For more information, see CMS' guidance on the changes.

The biggest benefit to the healthcare community is that the announcement has finally removed the biggest barrier to implementation: uncertainty. You can now talk to physicians confidently about the ICD-10 deadline and work with them throughout the yearlong transition to improve their documentation for you to choose the most appropriate, and specific, code.

You can forget about delays, waiting for ICD-11, and any other excuses you've heard about pushing off training for the transition. With the AMA and CMS working together, ICD-10 is certainly coming in just 86 days.

Friday, July 3, 2015

CMS proposes a few clarifications to its chronic care management billing code

At the beginning of 2015, CMS began reimbursing physicians for the care they provide to a particular group of their Medicare patients remotely and between visits. This new billing code, called Chronic Care Management (CCM), required that this remote care meet a few criteria, like patients must have two or more chronic conditions; the physician must establish a comprehensive care plan for the patient; and the remote care must take up at least 20 minutes of staff time over the course of the month.

This week CMS issued a proposed rule that seeks to clarify the use of the CCM billing code based on the many inquiries the agency has received since the code first came out.

“In reviewing the questions from hospitals on billing of CCM services, we identified several issues that we believe need to be clarified. Therefore, for CY 2016 and subsequent years, we are proposing additional requirements for hospitals to bill and receive OPPS payment for CPT code 99490. These proposed requirements, discussed below, are in addition to those already required…” CMS writes. 

CMS proposes that starting next year CCM can only be billed to if patient has an already established relationship with the provider using the code. “While we have always expected the hospital furnishing the clinical staff portion of CCM services, as described by CPT code 99490, to have an established relationship with the patient and to provide care and treatment to the patient during the course of illness… we have not previously specified through notice-and-comment rule making that the hospital must have an established relationship with the patient as a requirement for billing.” This prior relationship requirement would be an “explicit condition” on billing to the code, if the proposal is adopted.

CMS also wanted to clarify that while it was previously stated that only one physician can bill for the code for a given patient, the same goes for one hospital for a given patient. “The physician or other appropriate non-physician practitioner directing the CCM services should inform the beneficiary that only one hospital can furnish and be paid for these services during the calendar month service period.”

For more on CMS’ proposed changes and clarifications to CCM and other billing codes, check out the full proposal here (PDF).

Monday, June 29, 2015

Do your Patients Have the Knowledge to Make Good Food Choices?

Carbohydrates are your body's primary energy source! They should never be avoided, but it is important to understand that not all carbs are created equal!

Good Carb Bad Carb Trivia

Carbohydrates are an important part of a healthy diet, but there's much discussion about the good and bad carbs. So how do you know which is which? The answer is both simple and complex!

Click the picture above to launch the game!

Visit for more games.

Wednesday, June 10, 2015

CMS Issues New Telemedicine Guidelines and Approves Seven New Procedures in Move to Further Encourage Telehealth Initiatives

As the Medicare program expands telemedicine services, the opportunity may arise for sub-specialist pathologists to offer consultation services across state lines
More use of telemedicine across state borders has long been predicted as a way to improve access to care—particularly for patients in rural areas—as well as to give physicians and patients access to talented sub-specialists. Within the anatomic pathology profession, however, there are probably as many pathologists who view telemedicine across states lines to be a threat as there are pathologists who see it as an opportunity to raise the quality of care.
For its part, the Centers for Medicaid and Medicare Services (CMS) is taking a step forward in supporting the wider use of telemedicine. It is issuing new rules that expand reimbursement for remote patient services, a move that one day could benefit pathologists who provide sub-specialty pathology consultations with referring physicians across state lines.
CMS Added Seven Procedures to Its New Telehealth List
When final payment rules governing how Medicare will pay healthcare providers and suppliers in 2015 were released last October, CMS added seven procedures to the telehealth list of covered services, including annual wellness visits, psychotherapy services, and prolonged services in the office.
The American Telemedicine Association (ATA), which has long advocated for widespread use of telemedicine, praised the CMS for opening the door to greater access to telemedicine.
“It’s been a long time coming, but this ruling making signals a clear and bold step in the right direction for Medicare,” Jonathan Linkous, CEO of ATA, said in a statement. “This allows providers to use telemedicine technology to improve the cost and quality of healthcare delivery.”

What This Means for Pathologists
As the use of telemedicine becomes more common, states will be pressured to revise physician licensure laws to make it easier for out-of-state physicians to provide telemedicine services to in-state patients. For the medical laboratory profession, this might eventually make it possible for pathologists to one day be able to remotely monitor chronic patients using patient self-test devices that upload lab test results in real-time to their clinical laboratories.
For now, remote patient monitoring will continue to be available only to some Medicare patients. As Politico points out, CMS stopped short of dropping the provision requiring patients to be in a rural location to receive billable telemedicine services.
“We do not have authority to implement many of these revisions under the current statute,” Politico quoted CMS as stating. “The CMS Innovation Center is responsible for developing and testing new payment and service delivery models to lower costs and improve quality for Medicare, Medicaid, and CHIP beneficiaries. As part of that authority, the CMS Innovation Center can consider potential new payment and service delivery models to test changes to Medicare’s telehealth payment policies.”
In all, Medicare payments to telehealth are 0.8% higher in 2015.
Chronic-care Management Receives New Code: Causes Confusion
The CMS also added a new Current Procedural Terminology (CPT) code for chronic care management services. However, this change may not be as significant as first thought, because, as the ATA explained in a statement, “CMS has once again not allowed payment for data collection.”
In an articlePerry Payne, M.D., J.D., M.P.P., Assistant Research Professor in the Department of Health Policy at the George Washington University School of Public Health and Health Services (GW), and an adjunct at Howard Law, addressed the initial confusion over the Medicare rule allowing for payment for chronic-care management.
“Some media outlets and organizations that support telemedicine are reporting that CMS is paying for remote monitoring of chronic care management patients because of a new rule that offers providers reimbursement for non-visit based services for chronic care management patients,” Payne wrote. “However, this change is not focused on telehealth or digital health services as it can include many other activities.”
Health Plans Support Telemedicine
Greater CMS reimbursement for telemedicine likely will be the impetus needed for more private payers to jump on the telemedicine bandwagon. For now, AetnaHighmark, and Cigna are among the private insurers reimbursing for telemedicine and telehealth services, Healthcare IT News reported.
Highmark has been an early adopter of telemedicine. The private payer first offered primary care visits through Teladoc to beneficiaries in 2012. In January 2015, Highmark became the first health insurer in the country to offer teledermatology as a covered benefit.
“We need to make sure our members get the right care in the right setting, and telemedicine is a key tool to help make that setting more patient-centered,” said Donald R. Fischer, M.D., MBA, Highmark Senior Vice President and Chief Medical Officer, in a company statement. “Telemedicine is a resource that is critical to transforming the delivery of healthcare. It ensures faster access to high-quality healthcare while also helping to control costs.”
Texas Erects Barriers to Telemedicine
Telemedicine, however, still remains controversial. In April, the Texas Medical Board voted to rein in the practice of telemedicine in Texas by requiring physicians to conduct in-person visits with patients before providing diagnoses or prescribing drugs by phone or video, the Houston Chronicle reported. The only exception would be if a patient is at a healthcare facility such as a hospital, clinic, or pharmacy, and has another healthcare professional with them. Mental health visits are excluded from the rules.
“What the board is trying to do is really to keep patients safe,” Douglas W. Curran, M.D., a family physician and Vice Chair of the Texas Medical Association Board of Trustees, told the Houston Chronicle. “They want patients to be seen and evaluated so that patients can get the very best car possible. And I happen to agree with that.”
Opportunities for Pathologists
What pathologist will want to note is that CMS is taking another forward step in supporting the expanded use of telemedicine. That will put pressure on states to revise their physician licensure laws to make it easier for out-of-state physicians to provide telemedicine services to in-state patients. As that happens, this trend may open the door for more pathologists to provide sub-specialty pathology consultations with referring physicians across state lines and do patient consults as well (that are reimbursable to the consulting pathologists).

Read more: CMS Issues New Telemedicine Guidelines and Approves Seven New Procedures in Move to Further Encourage Telehealth Initiatives | Dark Daily