However, the ROI is not as readily apparent for many other services. Telemedicine is plagued by hazy economic cost and revenue measures, which are complicated by insurance reimbursement challenges. Specifically, health insurance providers traditionally only reimburse for services that mimic the normal interactions between patients and health institutions . Moreover, the reimbursement situation is somewhat recursive in that additional financial data are needed to provide evidence to insurance companies that telemedicine provides a financial benefit in reducing the higher costs of increased medical care . The future of reimbursement further complicates the financial landscape as specific reimbursement structures vary from state to state. Economic benefits (particularly when reimbursement is questionable) may not justify the equipment and communication investment costs incurred to install and maintain selected telemedicine services. Furthermore, recent economic conditions fueling the bankruptcy and closure of many health facilities in rural communities (often telemedicine spoke sites) may stunt telemedicine expansion to communities needing specialized services . 2.3.2. Recent Advancements There is growing evidence indicating that the benefits of telemedicine exceed the costs and that these benefits accrue to providers, patients, and society at large . In looking for financial benefits to the health care organization, some organizations are recognizing downstream revenues and well as the ability to avoid penalties ( i.e. , readmission penalties) facilitated by telemedicine services in their ROI assessments. Opportunities may also exist to leverage telemedicine to achieve recognitions (such as centers of excellence) or the authorization to provide a particular form of care at under-sourced sites in a health care network to capture business that would otherwise go elsewhere.
Int. J. Environ. Res. Public Health 2013 , 10 6478 In addition, there is some movement in reimbursement rules. Both Medicare and Medicaid have announced that they will be expanding telemedicine coverage (which may incentivize ACO development). The current federal Medicaid statute no longer recognizes telemedicine as a distinct service and has made a variety of Healthcare Common Procedure Coding System (HCPCS) codes (e.g., T1014 and Q3014) and Current Procedural Terminology (CPT) codes and modifiers (GT, U1-UD) available to those states that choose to cover such services under their Medicaid coverage . As of 2013, Medicare pays for Medicare Part B services that are furnished via real time interactive video including patient health education, telehealth consultations, and some mental health services . CMS is also working to extend telemedicine coverage through additional reimbursable services (e.g., transitional care management for post-discharge) and revisiting their urban/rural definitions (CMS has historically used strict county-based classifications to enforce its rural-only rule for telemedicine coverage) . In addition, from the general payer front, on 2 March 2010, Virginia’s legislature
- Winter '20