Contribution of Telehealth from fee-for-service payment to value-based payment

Contribution of Telehealth from fee-for-service payment to value-based payment

As healthcare payment reform accelerates, telemedicine and telehealth as a whole give providers a competitive advantage. With its emphasis on taking costs out of the system and their potential to maximize outcomes for individual patients and key populations, this modern technology has proved to be an important catalyst for the change to value-based healthcare.

As the model, slowly and steadily shifts from fee-for-service payment to value-based payment, telehealth will be used as both a fee-for-service revenue stream and a value-based cost-avoidance tool.

Let’s have a look at the areas where the contribution of telehealth from fee-for-service payment to value-based payment will have a significant impact.

  • Clinical Decision-Making:

Telehealth enhances collaborative working among healthcare professionals as it enables general practitioners and nurses to develop their skills and actively participate in diagnosis and decision-making by contributing primary care–specific knowledge to the consultation.

  • Detection of changes in Clinical Status:

The power of direct care i.e provider-to-patient via telemedicine technology is highly recognized by clinically integrated networks and ACOs. It facilitates early detection of the clinical status change and helps in reducing ED visits, as well as frees us the office appointment slots for fee-for-service patients.

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Detection of changes in clinical status plays an important role for patients with mild acute infections, where it needs follow-ups with close monitoring almost daily. With the help of telemedicine, appropriate actions can be taken immediately for any changes in the clinical statuses.

  • Billing:

The final rule for the 2020 Physician Fee Schedule gives hospitals and health systems more opportunities to use remote patient monitoring and paves the way for new telehealth programs, expanding the opportunities to use connected health services for management and coordination.

The American Medical Association has added several new codes to its 2020 CPT code set to support remote patient monitoring and telehealth services. These codes are intended to advance the adoption of digital health tools by clarifying payment complexities connected to the use of telehealth, remote patient monitoring, and other technologies.

  • Reimbursement:

Telemedicine reimbursement keeps on evolving as value-based models grow. With notable expansions in Medicare and Medicaid coverage, the reimbursement landscape looks promising for telehealth technologies.

Latest: CMS is adding more than 80 new telehealth services to the list of services covered by Medicare during the Coronavirus pandemic – and reiterating that all connected health services are now reimbursed at the same rate as in-person services.

  • Medicare Advantage:

The new proposed rule, effective from 2020, will allow Medicare Advantage to offer telehealth services as part of their basic benefits package. These benefits can be available in a variety of places, and you can use them at home instead of going to a health care facility.

Medicare Advantage plans will also include the coverage of services available for the treatment of COVID-19.

  • Community-based care:

Community-based health care is for people of all ages who need health care assistance at their homes. Community care services include home support, nursing, physiotherapy, and other rehabilitation services.

Growth of community-based care management and clinical response teams enable the success of remote patient monitoring (RPM), that is, technology alone will not succeed unless deployed within a functional system that responds to changes in clinical status, Many health care organizations are exploring strategies to leverage technology, including telehealth, to increase consumer engagement and focus on prevention and chronic care management outside the traditional physician office visit.

  • Remote monitoring:

Telehealth has the potential to improve remote monitoring and self-care strategies and, ultimately, reduce treatment costs by keeping people out of the hospital and emergency room, and reducing physician office visits.

Remote patient monitoring technology continues to evolve and enhance patient experience with much greater involvement in the management of their health, eliminating nursing and hospitalization costs.

  • Convergence of technologies:

The convergence of several technologies has revolutionized healthcare – the advent of EMRs and the ability of big data to aid in the analyses of protocols, remote patient monitoring, telemedicine, and artificial intelligence been a boon to the industry. Also, the balance of power has shifted from providers to the patient in a large part. Big data and technology platforms have affected several experiences. They offer patients/consumers the ability to adjust their behaviors based on others’ outcomes and the ability to connect with healthcare professionals at their convenience. Technology changes the way our society manages health overall—shifting the paradigm from fee for care to value for care.

The growing need telemedicine to cut costs and improve healthcare delivery is pushing providers away from long-lasting, volume-based healthcare models to the more practical and considered ‘value-based healthcare’ model.

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This care model aims to completely adjust payment and objective measures of medical quality of care. It drives outcomes and wellness in a proactive rather than a reactive model. value-based care model seems like a win-win situation for both patient and provider.


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