The Centers for Medicare and Medicare Services (CMS), part of Health and Human Services (HHS), talks a good game when it comes to telehealth and telemedicine as part of ‘healthcare reform’ and reducing same-cause readmissions–but gives away the real deal in bone-headed moves like this. In the US, telemedicine video consults are not reimbursable by Medicare unless one lives in a designated rural county. Because of population shifts, 97 counties are losing their rural designation, while 28 counties gain, based on Standard Metropolitan Statistical Areas (SMSAs). Thus Medicare recipients who’ve had the option of using video consults lose that option. The CEO of the American Telemedicine Association (ATA), Jonathan Linkous, has rightly been blasting this impending change, most recently here and to all who would listen (FierceMobileHealthcare), but Federal ears are on holiday. But this Editor will blast even harder and blunter: why Medicare does not include telemedicine as an cost-saving, effective and convenient option for every Medicare recipient, and encourage its use for both initial review and follow up to reduce readmissions, is (figuratively) insane. Here’s how it could be set up. Contract with a wide group of companies. Charge a $5 co-pay on initial visit. No charge on follow up. Work with seniors groups and senior centers–and the VA. Run the numbers and tweak appropriately. Americans have a government which squanders money (do not get this Editor, or The Gimlet Eye, started). With all the money being thrown at ‘pioneer ACOs’ and various awards programs, CMS can find some loose change under the couch! Hat tip to reader Ellen Fink-Samnick, MSW and her ‘Ethical Lens’ LinkedIn group joining the blast furnace.
Related: For those who want to dive deeper into rural vs. urban readmission rates (pretty much a draw), David Lee Scher, MD cites the following: from the Robert Wood Johnson Foundation, Interactive Map: The Revolving Door Syndrome; a study comparing rural and urban veterans’ admissions; and The Rural Hospital Advantage.