The General Accounting Office was commissioned by Congress to do a report on use of telemedicine and remote patient monitoring in Medicare and other federal health programs. (GAO Report) The GAO examined documents and interviewed a number of people to do the report. Everyone seems to agree that telemedicine can improve quality by improving access and convenience and can lower costs, since the equipment needed is cheap and there are no bricks and mortar requirements. Remote patient monitoring can be an effective way to make a timely identification of changes in condition and potentially avoid expensive hospitalizations and other care. Yet payers, including Medicare, continue to put barriers in the way of greater use, including location and service restrictions. Medicare basically only pays for it in rural areas or where there is shortage of qualified clinicians, so in total the program pays a ridiculously small amount for these services each year. Only .2% of beneficiaries used a telemedicine service in 2014, for a total cost to Medicare of $14 million.
Medicare also only pays for remote patient monitoring in isolated circumstances. The program spent about $200 million for various types of cardiac condition remote monitoring in 2014. CMS does have demonstrations in which it allows more flexible use of these services and Medicare Advantage plans often utilize them more frequently. Medicaid policies on telehealth and remote monitoring are diverse, since they are run by the states, but from GAO’s review it appears that most Medicaid programs utilize almost no telemedicine visits. The Department of Defense and the Veterans’ Affairs health programs are much more accommodating in the use of telehealth. Given the likely quality and cost benefits, as we have suggested before, it is long overdue for the federal government to loosen restrictions on telemedicine use and to eliminate needless cross-state licensure restrictions that make it difficult for providers in one state to treat patients in another. Then all those dollars investors are pouring into telemedicine might finally get a return.