AMA eyes permanent telemedicine reimbursement

(Image Credit: AdobeStock/Jacob Lund)

As telemedicine continues to increase in popularity, including in ophthalmology, the American Medical Association announced plans to lobby for an indefinite extension of Medicare reimbursement for telemedicine services and fight the December 31, 2024, sunset date when Medicare plans to cease reimbursement for these services.

The American Academy of Ophthalmology noted on its website that from remote screenings for diabetic retinopathy to online refraction, telemedicine provides new ways for patients to access eye care – especially those who live in remote areas or may not otherwise be able to see a provider.¹

“These technologies pose new challenges for both regulatory agencies and state and federal policymakers,” the Academy noted on its website. “Both the U.S. government and private payers are beginning to address coverage of telemedicine services, interstate medical licensure and laws around the use of specific technologies.”

Prior to the COVID-19 pandemic, telemedicine was not reimbursed by Medicare. This created a hurdle to the wide-scale adoption of the technology that could enable physicians to see greater numbers of patients more efficiently and with less inconvenience to patients than office visits.

Amid the pandemic, the Centers for Medicare and Medicaid Services (CMS) in 2020 quickly shifted its policy to cover telemedicine during the COVID-19 public health emergency in effort to limit in-person contact while still offering patients access to providers. Overnight, the percentage of telehealth usage skyrocketed during the pandemic.²

Even though the numbers have since declined rapidly as COVID subsided, nearly 70% of physicians want to continue providing telemedicine services, the AMA said in its news release, based on surveys of its members.

“Paying for telemedicine services means greater convenience for patients and less need to use petroleum-powered vehicles for patients’ and doctors’ transit from their homes to physicians’ offices,” according to a resolution introduced by the Missouri State Medical Association recently at the 2024 AMA House of Delegates (HOD) meeting.

According to a release, the resolution asks the AMA/Specialty Society Relative Value Scale (RVS) Update Committee, known as the RUC, to evaluate telemedicine and determine a relative value unit (RVU) value. The RUC committee is dedicated to describing the resources required to provide physician services which CMS considers in developing RVUs.³

The resolution also requested that RVU determinations be made with recommendations for higher reimbursement rates for in-person office visits because of the higher costs related to maintaining brick-and-mortar facilities.

An AMA survey of its physicians found 74.4% reported that telehealth was used in their medical practices in 2022, which is nearly three times the number from 2018. Videoconferencing with patients was the main driver for the change, according to the findings of an AMA Policy Research Perspectives report on telemedicine. Just 14.3% of physicians had the ability to use telehealth to video conference with patients in 2018, compared with 66.3% of physicians in 2022.⁴

“While the immediate need due to the COVID-19 pandemic has passed, telehealth and especially remote visits with patients, has become part of the mainstream way in which physicians deliver care,” Carol K. Kane, PhD, the AMA’s director of economics and health policy research, wrote in the report.

There have been numerous calls over the last 2 years by the AMA and other medical groups to maintain telemedicine as a tool for faster routine visits, low-acuity questions, and to help patients who otherwise would need to travel long distances or could not afford to do in-person visits.

In July, the Bipartisan Policy Center released a report that focused on the future of telehealth.⁵

In the report, the authors pointed it is key for Congress to “preserve telehealth access and commit to establishing a more sustainable, long-term telehealth reimbursement strategy, and ensuring high-quality virtual care through robust oversight and quality assurance.”

The group expects Congress to maintain current telehealth provisions through 2026, with key committees in both the House and Senate expressing an interest in extending telehealth policies.

“The Bipartisan Policy Center anticipates that Congress will extend telehealth flexibilities before authorities expire,” the authors concluded.

References:

1. Telemedicine. Telemedicine. American Academy of Ophthalmology. Published December 3, 2014. Accessed July 23, 2024. https://www.aao.org/education/clinical-statement/telemedicine

2. CMS. Centers for Medicare & Medicaid Services. Cmsgov. Published online January 4, 2020. doi:https://doi.org/99908

3. ‌RVS Update Committee (RUC). American Medical Association. https://www.ama-assn.org/about/rvs-update-committee-ruc/rvs-update-committee-ruc

4. ‌Kane C. Policy Research Perspectives Telehealth in 2022: Availability Remains Strong but Accounts for a Small Share of Patient Visits for Most Physicians. https://www.ama-assn.org/system/files/2022-prp-telehealth.pdf

5. M. Sandalow, J. Harris, M. Curtis, M Werber Serafini; Positioning Telehealth Policy to Ensure High-Quality, Cost-Effective Care. Bipartisan Policy. Published July 15, 2024. Accessed July 22, 2024. https://bipartisanpolicy.org/report/positioning-telehealth-policy-to-ensure-high-quality-cost-effective-care/