Medicare may allow payment for virtual consults

CMS has proposed new regulations that, as of 2009, would allow physicians to bill Medicare for follow-up inpatient consultations, along with adding 56 new measures to the Physician Quality Reporting Initiative. CMS projects that under the new rule, it would pay $54 billion to 980,000 physicians and other providers next year. If the rules are approved, they would represent a major moment in the progress of "e-visits," few of which are reimbursed by insurers to date.

Under the proposed rule, CMS would add new codes to its list, designating consultations done electronically with a patient's attending physician when the consulting doctor wasn't available for an in-person discussion. To make sure hospitals don't worry about using the codes, the rule would give hospitals a safe harbor from self-referral limits. The exception falls under rules allowing payments from hospitals to medical staff members under programs rewarding quality care, such as value-based purchasing programs.

Since CMS hasn't provided any technical standards for such visits, it seems likely that if the rule is approved, it will trigger a wave of technical experimentation around how to support such visits. After all, while providers like Duke have put portals in place to support some forms of physician-patient communication, it's still rare for hospitals to have infrastructure in place to support any form of telemedical consult. I expect to see a big scramble among IT departments if CMS moves ahead.

To learn more about the proposal:
- read this Modern Healthcare article (reg. req.)

Related Articles:
Insurers keep getting on web visit bandwagon
Health plans begin reimbursing for 'virtual visits'
Physicians offer 'e-care'

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