The Lynx Group

Managed Care, Oncology, and Telehealth in the Era of COVID-19

August 2020, Vol 11, Special Issue: Payers' Perspectives in Oncology

“COVID-19 has been like a 9/11 moment in healthcare,” said Michael Kolodziej, MD, Senior Advisor, ADVI Health, at the Association for Value-Based Cancer Care (AVBCC) July 28, 2020, webcast. “We don’t have a playbook. It’s required us to rethink.”

It is hard to think of an aspect of the healthcare payment system that has undergone more rapid or significant “rethinking” than the reimbursement structure for telehealth. Telemedicine, which was still in relative infancy when the pandemic hit, exploded virtually overnight, with visits growing exponentially. Public and commercial payers adapted their reimbursement structures, with telemedicine visits for most types of medical care now being paid at parity with in-person visits.

A few months into the coronavirus pandemic, although there have been many technical glitches and growing pains, many practices and patients alike have found that for a subset of visits, at least, telehealth serves them as well as in-person visits. But how long will reimbursement parity continue?

“Telehealth has been a good solution to a bad problem, and it was the right thing to do to reimburse at parity, but I am concerned that payers will reduce reimbursement as foot traffic picks up, and when reimbursement goes down, providers will stop using it,” said Dr Kolodziej.

That is already happening, suggested Lee N. Newcomer, MD, MHA, Principal, Lee N Newcomer Consulting, Minneapolis, MN. “We’re already seeing payers begin to reduce reimbursement as COVID-free clinics are set up. But I think it’s a very efficient way to use physician time, and I would like to see it established as another tool in the toolbox for the future.”

Harvard Pilgrim Health Care continues to pay for telemedicine visits at parity, and does not charge any cost-sharing to individuals who are getting virtual care, according to Senior Vice President and Chief Medical Officer Michael Sherman, MD, MBA, MS. “But I’m not sure if that is sustainable long-term. Who is paying for it? It’s everyone. It’s the insurance pool.”

Some of this discussion may be premature, suggested Bryan Loy, MD, MBA, Physician Lead, Oncology, Laboratory, and Personalized Medicine, Humana. “I don’t think COVID-19 is done with us, and we’re not done with COVID-19. We are still learning. From oncology providers, I hear over and over, ‘Don’t take this away,’” Dr Loy noted.

One challenging area is the question of reimbursement for virtual visits that are strictly by phone call, with no video component.

“Historically, we did not count phone calls as reimbursable for telehealth, out of concern that they would be used for things that were not bona fide visits and did not merit separate reimbursement. COVID-19 changed that, and we are covering phone calls for now. But there’s a real question as to which ones you should reimburse for,” said Dr Loy.

But Dr Newcomer said he didn’t begrudge paying a primary care provider or a specialist a little more margin for a phone call. “I’d rather have that doctor talking to me and helping me to monitor my disease than doing another $3000 procedure. I’m happy to give them the extra margin.”

When Dr Kolodziej polled the panel members as to whether they thought managed care payers would still be reimbursing telehealth at parity in 6 months, the panelists were divided.

Dr Newcomer was the only one to offer an unqualified yes. Steven R. Peskin, MD, MBA, FACP, Executive Medical Director, Population Health, Horizon Blue Cross Blue Shield of New Jersey, gave a “qualified yes,” whereas Dr Kolodziej said no. Dr Sherman said that it will all depend on the persistence of the COVID crisis. “It’s not a simple answer,” concluded Dr Loy.

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