National policies for telemedicine reimbursement should aim to improve access to care, a metric that affects rural and urban residents alike, four health and emergency medicine researchers wrote in an Oct. 12 op-ed published in Health Affairs.
Today's telemedicine reimbursement policies, as established by CMS, focus on geographic distance to healthcare services, prioritizing the needs of rural residents who live in areas with a shortage of health professionals. Rural areas tend to have one-third the number of practicing specialists per capita compared to urban areas, according to the authors.
"But while geography is an important aspect of access to healthcare, it fails to accurately capture the relationship between supply (providers) and demand (patients) within an area," the authors wrote. "We are concerned that while rural America has access problems because there are not enough doctors, urban America has access problems because there are not enough appointments."
According to one study of primary care practices across 10 states, rural Medicaid patients were offered an appointment 80 percent of the time, while urban patients were offered appointments only 60 percent of the time. Thus, to shift to a focus on access, the authors proposed policymakers consider patient access as a function of "appointment timeliness," independent of geography.
Transitioning telemedicine policies to more easily reimburse physicians for providing services in areas that lack access to healthcare would continue to support rural residents while also giving urban residents the attention they need, the authors wrote.
"The best way to care for patients in rural environments is to build programs that synchronize rural and urban care," the authors wrote. "Health systems, patients and providers are all poised to interact with the healthcare system differently; aligning payment structures to focus on the availability of timely care instead of historic geographic constructs is essential."
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