Telehealth and the Telephone

This episode of Policy in Plainer English tackles Telehealth and the Telephone, with Dr. Audrey Von Lepel (NOTCH) and Dr. Adam Greenlee (Community Health Centers of Burlington). We thank Northern Counties Health Care for supporting this series. For all the details you could ever want on telehealth during COVID-19, visit this provider resource page from Bi-State Primary Care Association. 

Update (4/30): Since this episode was first recorded, Medicare has adjusted audio-only telephone options, the telephone is still not a fully recognized option for delivering health care services during COVID-19, but it is much closer to being there.  

There are a few reasons why using the telephone is a hot topic right now. The COVID-19 response opened up options that didn’t previously exist, importantly Vermont recognizes the telephone as a way to deliver telemedicine (the part of telehealth that replaces and office visit) and insurers are offering more options for what we call “triage calls”, or more formally brief telecommunications initiated by the patient. That last type of call, for Medicaid and Vermont Commercial payers, does not impose any cost share on patients.

Medicare doesn’t play by the same rules.

For one thing, those brief calls do have a cost share – something which many people see as unfair. Cold comfort is that, for the length of the emergency, providers won’t be forced to collect the co-pay from patients. they can pay it themselves instead.

The even bigger issue is that Medicare does not recognize the telephone as a device that can replace an audio-visual connection for telehealth services. This rule plays out different ways for different provider types. For federally qualified health centers, we have a code (G0071) that can be used to indicate a telephone service – and it pays $24. If we waive the co-pay, that’s more like $20. You don’t need to know a whole lot about health care economics to know that you cannot run a medical practice when the entirety of a doctor’s visit, from patient scheduling to chart review to prescription reconciliation to time on the phone to follow up and all the administration that goes along, reimburses you $20. 

As this episode points out, the problem isn’t just one of revenues during COVID-19, it’s the problem of what health care will look like after COVID-19 – who has access, who doesn’t, and whether doctors and patients will be able to work together to design the kind of health care that ensures nobody gets left out.