Insurance change is driving interest in telemedicine

Conestoga Eye, an ophthalmology practice in East Hempfield Township, Lancaster County, has transitioned almost all of its first interactions with patients to online visits.

Depending on the type of practice, Conestoga Eye founder and ophthalmologist Dr. David Silbert suggests that other doctors look into limiting the number of patients they see in person to cases that can’t be solved via online check-ups, also known as telehealth.

“I suspect that the default for providers is that if someone says they have a problem, you bring them into the practice instead of first having a face-to-face video chat,” Silbert said. “You’re first interaction should be through telehealth and you shouldn’t have a visit without telehealth first.”

Before coronavirus, few health care providers were offering telehealth options, and a majority of insurers offering limited to zero payments for the service. For this reason, many providers never invested in the technology.

In Mid-March, the Centers for Medicare and Medicaid Services (CMS) announced that it would be rolling back a number of federal provisions to allow more providers to get paid for telehealth visits with a Medicare or Medicaid beneficiary.

“This is a huge deal,” said Heather Modjesky, senior administrator and director of community outreach at Conestoga Eye. “Prior to CMS’ update, you got paid nothing. Providers would only be paid a marginal amount if they were in what is considered a “medical wasteland.”

Other insurance providers, such as Capital BlueCross and Highmark Blue Cross Blue Shield have waived deductibles, copayments and coinsurance for telehealth visits related to COVID-19.

Now that funding isn’t a barrier to meeting online with many of his patients, Silbert said Conestoga Eye has been able to greatly reduce the number of people moving in and out of its offices to only the patients that need a face-to-face meeting with a doctor.

“We have a chance of really shutting this down in our area,” Silbert said of his fellow health care providers. “If I have someone with an eye lid lesion, I can prescribe them medicine over the phone. There is a lot you can do with a patient’s history and by looking at it.”

Modjesky worried that older patients would find it difficult to do the steps needed to get on a call with one of the provider’s doctors.

“Is the older generation going to be able to get passed that?” she asked. “What we’ve found is that most patients are very open to it. They get the email, they find the app and they know how to work it.”

Most of the reluctance came from parents who worried that their kids won’t get the same treatment as they would in person, Modjesky said.

“There is this impression that the video isn’t equivalent to the office visit,” she said. “It’s a misnomer but it can be hard to talk parents out of that.”