Despite demand, video health exams largely not covered by insurance in Pennsylvania

Despite demand, video health exams largely not covered by insurance in Pennsylvania

By Sean D. Hamill / Pittsburgh Post-Gazette

This past Thursday, Susan Kressly, a pediatrician in Warrington, Pa., a Philadelphia suburb, told the mother of a boy who called to say she thought her son had the flu that she would have to bring him into the office be evaluated.

That was not the best scenario. The child’s brother came down with the flu two days earlier so the other son probably did have the flu. Bringing him to the doctor’s office meant potentially spreading the highly infectious disease to still other people.

“But his mom said he was also having breathing episodes, and I could not do a proper examination over the phone,” said Dr. Kressly, who is also president of the Pennsylvania chapter of the American Academy of Pediatrics. “I needed a visual examination to make a proper assessment.”

She could have done that via Skype or some other Internet video connection to the office and let the sick boy stay home.

But Dr. Kressly, like nearly every other physician in Pennsylvania, does not do so-called “telehealth” video examinations because insurance companies do not generally reimburse doctors for home-to-office telehealth visits with patients.

“I would do [telehealth visits] tomorrow if I could get insurance companies to pay for it,” Dr. Kressly said.

So would thousands of other physicians across the state, in particular during flu season when the goal of limiting contact between those with the virus and everyone else is paramount to stifling its spread.

“The less contact the general population has with someone with the flu the better,” said Larry John, a family practice physician for 35 years who works at UPMC St. Margaret near Aspinwall. “So, keeping people out of a doctor’s office or a hospital would be good.”

Currently, 21 states do have some form of what’s called a “parity” law requiring private insurance companies to reimburse for televisits, according to the September 2014 review of the laws by the American Telemedicine Association. Pennsylvania is not one of them.

“E-visits [via a form of email] and telehealth is definitely going to happen as a way of providing care,” said Dr. John, president of the Allegheny County Medical Society. “It’s not happening yet widely. But we’ve been talking about this in the medical society for a long time.”

Of course, many family and pediatric physicians have and continue to keep patients from coming to their office or a hospital just based on a phone evaluation.

The caveat, Dr. John and others said, is that doctors are reluctant to use just a phone conversation as a basis for diagnosis and advice — or filling a prescription for Tamiflu, for example — for everyone. They need to have had a long-term relationship with the patient and know him or her well enough to feel comfortable without an in-person visit.

But there are still those visits where, like with Dr. Kressly last week, even if the doctor knows the patient well, a visual examination is needed.

Jeff Kile, a pediatrician in Kingston, Luzerne County, said video conferencing with patients has inherent benefits over just a phone call.

“Video conferencing can be helpful to see the patient and discuss their symptoms with them, and decide if they need to be evaluated face to face,” he said in an email interview in between seeing patients last week. “You can get a better ‘picture’ of what is going on compared to a telephonic consult.”

Dr. Kile, who also recently served a term on the American Academy of Pediatrics’ telehealth executive committee, is looking forward not only to the day when you can see the patient in a video conference, but also when the patient, with help, has access to “telemedical” devices, such as a stethoscope and otoscope (device that looks into the ears). Such devices hook up to the same computer sending video and transmit images and sounds to the physician to help with a remote diagnosis.

Such equipment is already being used around the country, including several school health offices, where a school nurse uses the telemedical devices to help with a video diagnosis with a physician in a distant location.

So if the technology makes so much sense, what is the holdup to insurers in paying for such visits?

There is no nationwide telemedicine “parity” law, which would require reimbursement by all insurers for video conference visits with a doctor.

In addition, Medicare does not yet cover televisits — something experts say would be a major boost to telemedicine because Medicare is so massive that private insurers tend to follow its lead.

That has left coverage decisions to the states. Why not in Pennsylvania?

“Whether it’s liquor laws or issues like telehealth, we are not a state that moves very fast,” said Donald Fischer, Highmark’s chief medical officer. “But we’d like to take the insurance obstacle off the table.”

Dr. Fischer, a pediatric cardiologist by training who worked at Children’s Hospital of Pittsburgh of UPMC, said Highmark is still piloting programs where telehealth is used by doctors it reimburses, including through a private company, Teladoc. The company has a team of doctors that does video conferencing to diagnose patients, but it is rarely a local, Pittsburgh-area doctor who would be that patient’s personal doctor.

He said the company is still working through the various issues of making the process secure, finding an appropriate payment system and a way to verify the visit took place.

Stephen Perkins, vice president of medical affairs for UPMC Health Plan, said another barrier has been a reluctance on the part of physicians to welcome telehealth, whether its video conferencing or email conversations with patients.

As a result, even though UPMC Health Plan has covered approved telehealth visits since 2009, “There is kind of a mixed acceptance of this” by physicians, he said.

Taken together “there are a lot of barriers to overcome” before telehealth is widely used in Pennsylvania, Dr. Fischer said. “But I think we’ll get there.”

Sean D. Hamill: or 412-263-2579.

Source: Pittsburgh Gazzette