California Health Benefits Review Program Analysis of California Senate Bill SB 289 Telephonic and Electronic Patient Management
Year: 2015
Type: article
Abstract: SB 289 would require state-regulated health insurance, after January 1, 2016, to cover and reimburse physicians for telephonic and electronic E/M services for established patients.If passed, SB 289 would require carriers to pay for those services provided via telephone and e-mail, live videoconferencing, and "store-and-forward," a method by which patients capture medical information and transmit that information to physicians to evaluate at a later time.Based on SB 289's language, CHBRP limits analysis of services delivered via telephone and e-mail to cases where an established patient initiates contact with the health care provider.Finally, SB 289 specifies that reimbursements must be equivalent in "complexity and time expenditure."CHBRP uses the American Medical Association's Current Procedural Terminology (CPT) coding descriptions for the required amount of time spent on encounters and the complexity of a patient's illness. CONTEXT FOR BILL CONSIDERATIONWhat is telehealth?California law currently includes two methods of electronic communication in its definition of telehealth: live videoconferencing and store-and-forward.Although current law recognizes these two modalities as telehealth, it does not require or set standards for reimbursement.SB 289 would require reimbursement for these modalities, and would also require coverage and reimbursement for telephone and e-mail.Therefore, CHBRP analyzed the impact of SB 289 for four modalities: telephone, e-mail, live videoconferencing, and store-andforward.Patient interest in technology for medical transactions: A December 2014 survey of patients in the U.S. found that 64% of patients were interested in using online video.Interest in live videoconferencing with providers peaked among younger adults (74% of respondents ages 18 to AT A GLANCE Senate Bill SB 289 (introduced February 2015) would require health insurance carriers to cover and reimburse physicians and nonphysicians for patientinitiated evaluation and management (E/M) services for telephone, e-mail, live videoconference, and store-andforward.Only services provided to established patients would be eligible Impact on benefit coverage.CHBRP estimates that in 2015, 11.7 million enrollees have coverage for telephone and e-mail and 19.2 million have coverage for other telehealth modalities covered by SB 289.Postmandate, all 24.6 million California enrollees with state-regulated coverage would have benefit coverage for these modalities. Impact on utilization.CHBRP estimates the share of telehealth visits to in-person visits could range from 7.4% to 29.2%.In person visits could decrease by 0.9% to 15.0% depending on patient/provider take-up of all telehealth modalities. EHBs.SB 289 does not appear to add services health insurers must cover, but affects the setting in which already-covered services are provided.Therefore, SB 289 does not appear to exceed EHBs. Medical effectiveness.o There is insufficient evidence to determine whether E/M services provided via telephone or e-mail are as effective as medical care provided in-person.o The evidence suggests that medical care provided by live videoconferencing and storeand-forward is at least as effective as medical care provided in person for those diseases and conditions studied. Public health.If enacted, patient experience would improve as physicians increase e-mail and telephone responses to patient inquiries, increased convenience, and reduce or eliminate travel times to in-person visits. Long-term impacts.Technology will continue to drive changes in telehealth.Electronic health records, online patient portals, and increased use of smart phones will increase demand for these types of services.Insurers and physicians could respond by expanding their capacity to deliver those services in a secure manner. Key Findings: Analysis of California Senate Bill SB 289Current as of April 14, 2015 www.chbrp.orgii 34) and declined gradually to 65% among respondents ages 55 to 64, before significantly decreasing among adults 65 and older.The survey found that 60% of respondents would rather use live videoconferencing to obtain a refill for their prescription drug rather than visit their doctor's office (American Well, 2015).
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W2972863246