Somewhat buried in the Centers for Medicare and Medicaid Services' proposed rule Tuesday cancelling two mandatory bundles for cardiac and joint care and scaling back a program for hips and knees, is a provision to allow for greater reimbursement for telehealth in the comprehensive care for joint-replacement model.
CMS will include practice expense payment for the comparable office and other outpatient visits. These services were not included in the past because CMS said it believed any practice expenses incurred were marginal or paid through other services.
Stakeholders told CMS this was not that case, that there were additional costs in the delivery of telehealth services such as maintaining the telecommunications equipment, software and security.
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In the proposed rule, CMS is waiving the requirements for distant site payments, such as allowing for reimbursement for telehealth only if a patient can't get to a facility.
However, researchers from the University of Wisconsin at Madison question whether e-visits are the touted innovation answer for physicians to handle routine questions, lower the cost of care and see more patients.
Their research of 140,000 patient encounters over the last five years shows the opposite effect. E-visits trigger an increase in office visits and phone consults, reduce the number of new patients seen by providers and offer no noticeable improvement in patient health, according to the study published through the Wisconsin School of Business.
While patients see e-visits as a low-cost alternative to reach their doctor, bypassing administrative staff and nurses, physicians experience a 6 percent increase in office visits, the study said.
One reason is these additional communications create more opportunities for physicians to feel obligated to see the patient in the office, according to Hessam Bavafa, Wisconsin School of Business assistant professor of operations and information management.