DSMT telehealth services now reimbursed, but work remains

The concept of telehealth is growing in popularity as new technology emerges and as patients and providers become more technologically savvy, discovering new and more convenient ways of communicating.

Telehealth is commonly defined as the delivery of health-related services and information via telecommunications technologies.

Donna Tomky

As a society, we are increasingly embracing more informal communications venues, such as phone conversations, email exchanges, videochatting and texting, for example. However, these vehicles are not recognized as reimbursable telehealth delivery systems. Inflexible and outdated policies, laws and regulations hamper innovation in this area, and make it more difficult for health care providers to widely incorporate these systems into their programs since they are not reimbursed at this time.

Use of these technologies has the potential to revolutionize the way health education is delivered and information is exchanged.

A step forward

Telehealth is of particular interest to diabetes educators who are searching for ways to increase patient access to their services. Telehealth technologies could potentially magnify the reach of educators and help them meet the needs of the ever-growing diabetes population.

In early 2011, changes were implemented to the Physician Fee Schedule for Medicare, which could make a positive difference in the future delivery of diabetes self-management training (DSMT). In 2010, the American Association of Diabetes Educators and the American Association of Clinical Endocrinologists requested that CMS make changes to the 2011 Physician Fee Schedule for Medicare to increase reimbursement for DSMT G-codes and to add individual or group DSMT (G0108 and G0109) to the list of reimbursable telehealth services. These changes went into effect on Jan. 1.

This is a significant step forward and may ensure that a number of currently underserved individuals gain access to DSMT. However, in its current form, there are many restrictions on the reimbursement policy for telehealth and not everyone can bill for it.

First, to be reimbursed for providing any type of Medicare-reimbursed telehealth services, the following requirements must be met:

• Services must be delivered to a beneficiary in an eligible facility known as an “originating site” (such as physician or practitioner offices, hospitals, critical access hospitals, rural health clinics, federally qualified health centers, hospital-based or critical access hospital-based renal dialysis centers, skilled nursing facilities and community mental health centers).
• In general, originating sites must be located in a federally designated rural Health Professional Shortage Area in a county that is not in a Metropolitan Statistical Area or from an entity that is involved in an approved federal telemedicine demonstration project.
• The care/services must be conducted by a physician; nurse midwife; clinical psychologist; registered dietitian or nutritional professional; nurse practitioner; physician assistant; clinical nurse specialist; or clinical social worker.
• The patient must be present for an encounter, which involves interactive, two-way audio and video telecommunications and provides real-time exchanges between the practitioner and the individual beneficiary.

Overcoming barriers

Besides these general criteria, DSMT telehealth services must meet separate requirements.

Similar to reimbursement requirements for in-person education, the telehealth services must be provided within an accredited diabetes education program. CMS will also require that a minimum of 1 hour of in-person instruction is provided in the self-administration of injectable drugs to the individual during the year after the initial DSMT service.

The addition of DSMT to the list of reimbursable telehealth services is an important advancement for the field, but the restrictions placed on qualifying sites, approved providers and communications vehicles hinder the widespread adoption of these methods and others.

Before the diabetes community can realize the full potential of telehealth services, we must overcome these significant barriers.

First, diabetes educators must be added to the list of approved providers for DSMT telehealth services — since diabetes educators are currently the professionals who are trained and experienced in the delivery of DSMT.

Secondly, the restrictions for “originating sites” must be loosened. Why should we require the patient to travel to an originating site if they have the ability to connect from home for one-on-one sessions? In addition, the prohibition on telehealth services for beneficiaries in metropolitan areas should be waived because many people with diabetes living in large metropolitan areas also face many barriers to getting the health services they need, which could be improved by the use of telehealth services.

Also, expansion of CMS’ definition of reimbursable telecommunications vehicles is essential. Currently, email exchanges, phone support, texting and other emerging technologies are not considered reimbursable as telecommunications systems. However, with a disease such as diabetes, which requires daily self-management and difficult behavior changes, informal communications between patient and providers could significantly bridge the gap between the care delivered at provider offices, programs or hospitals and the patient’s daily self-care.

Growing potential

As health care professionals, we have not yet begun to scratch the surface of the potential for telehealth services. If we hope to keep up with the rising tide of those with diabetes in this country, we must find ways of extending the reach of our limited diabetes work force and broadening their effect.

Telehealth could be a major part of this process, but more work needs to be done to integrate it into a financially sustainable model of diabetes care. CMS cannot change the definition of telehealth and/or the criteria without Congress changing the telehealth bill, so it is up to us — the diabetes community — to advocate for these changes.

Donna Tomky, MSN, RN, C-NP, CDE, is president of the American Association of Diabetes Educators.

Disclosure: Ms. Tomky reports no relevant financial disclosures.