By Mike Grove
Based on the ATA 2012 Informational Session “Learn How to Get Paid and Create Revenue for your Telehealth Initiative” hosted by Nina M. Antoniotti, RN, MBA, PhD, Director of TeleHealth Business. Marshfield Clinic, Marshfield, WI, USA.
For someone like me who is relatively new to telehealth and not as familiar with reimbursement issues, this was a highly informative session as my three pages of single-spaced notes attest! I certainly wasn’t alone as this was the most well-attended concurrent session I visited at ATA 20 12. No surprise as everyone from vendors to clinicians to policy experts is interested in understanding how the money flows vis a vis telehealth applications. Dr. Antoniotti is clearly one of the foremost telehealth reimbursement experts in the country which was evidenced by her ability to address state-specific questions thrown her way by the audience.
Dr. Antoniotti defined the payment buckets as coming from one of three sources: Medicare, Medicaid, and everyone else (including private payers and out-of-pocket). As simple as that may sound, she emphasized the profoundly different rules each has for payment which explains much of the misunderstanding around payment for telehealth services. She presented a helpful and decidedly simple payment algorithm used by CMS when considering reimbursement and noted that the variation in state-administered Medicaid payments which require localized understanding of payment issues.
Several general reimbursement strategies were highlighted which suggested a sort of philosophical reconsideration of institutional revenue. Most broadly, vertical alignment of patient ancillary services was mentioned as a strategy to keep a patient within one’s system for as much of the care process as possible. She also suggested that cost avoidance and expense reduction should really be thought of as a revenue source, meaning that readmissions and length of stay (LOS) are areas to be reexamined when considering telehealth services. Specifically, targeting clinical services that historically have high no-show rates as prime candidates for telehealth efforts is a good way to begin to build the internal business case.
The take-away point from Dr. Antoniotti was “if you get reimbursed for an in-person service, assume you will for a telehealth service as well.” To me, this sounded like an interesting problem as it appears that there is room for creative thinking when it comes to use of telehealth services. It solidified the point I heard over and over during ATA…that telehealth should be embedded within processes and essentially synonymous with healthcare delivery.