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I’ve been thinking about how to make healthcare more convenient since I myself became a patient in 2010. Diagnosed with an illness I’d need to manage forever, the idea of coming back to a doctor’s office regularly just to check in sounded crazy. I couldn’t call or text for routine check-ins, even though it was essentially the same thing. I had to physically go to the office.
Two years ago, I founded a company specifically to help contact lens wearers avoid repeat check-ins. Our service, like nearly all online health consultations, is not reimbursable under most insurance plans. This lack of insurance coverage for virtual services has effectively blocked many doctors from offering them.
But finally, that could be changing.
In July, the Centers for Medicare & Medicaid Services (CMS) outlined potentially historic changes to the way it allows doctors and patients to interact. The new rules, published in a 1,400+ page document, indicate a refreshing change in mentality toward telemedicine, inspiring optimism from providers, patients, and the companies who serve the U.S. healthcare industry.
The CMS is accepting public commentary on this proposal through September 10, 2018 — just a few days away — which is why I want to outline here exactly why I think these changes would provide a tremendous boost to the success and growth of telemedicine as a whole. I encourage you to share your own opinion on the rules with the CMS before the deadline.
If the CMS were to adopt these new guidelines, they could have far-reaching effects on the healthcare ecosystem, opening the door for virtual check-ins and digital visits that are currently only covered on an extremely limited basis by Medicare.
To sum it up: Medicare has proposed compensating doctors for seeing patients virtually.
There would still be a few key limitations, like the requirement that patients have a preexisting relationship with their physician. In other words, doctor-patient relationships could not be established virtually. However, the CMS is the single largest payer of healthcare in the U.S. If Medicare were to start covering virtual visits, more doctors would offer them and more patients would use them. It’s exactly the spark that telehealth needs to reach the next level.
The doctor is online
Most Americans already use their computers and mobile devices for key behaviors such as banking and shopping and would welcome digital-first healthcare with open arms. But many digital healthcare companies who, despite product/market fit and huge growth potential, have been limited by outdated CMS policies have been stopped from moving forward. For this sector, Medicare can remove a huge roadblock by covering virtual visits.
But the real intrigue is in the subtext. This CMS document is a glimpse into its vision for the future. If a digital-first system has become a priority, this loosening of the reins could lead to something much larger: incentivizing telemedicine in the future. Early success could create a snowball effect that truly drives adoption of virtual medicine.
This isn’t just a big deal for Medicare users. The CMS is a bellwether for the healthcare sector. Where it goes, so does everyone else. Incentivized telemedicine through Medicare would provide telehealth companies with the opening they’ve been waiting for to achieve stratospheric growth, while inspiring new startups to redefine healthcare as we know it.
Historically, legislation has had the effect of unlocking doors for entrepreneurs, inspiring change in positive ways. Similar to how the evolving music landscape of the 2000s gave birth to music juggernauts like Spotify, or more recently, how evolving cannabis laws are creating tremendous opportunities for entrepreneurs, the next generation of healthcare companies could be founded on the promise of a more open, digital-friendly healthcare system.
A spark for startups is also a motivator for investors. The telemedicine market is already projected to top $35 billion by 2020. But these proposed rules, if adopted, would drive that number even higher. Renewed optimism around a space is already being seen with significantly increased investment in digital health companies, with 2018 on pace to be another record-breaking year.
A healthy outlook
Most importantly, the updated CMS rules will remove barriers for those who need care. Streamlining visits via virtual check-ins will help to assuage bottlenecks. This is especially true for regular check-ins which can feel like a huge waste of time for patient and doctor alike. Adopting virtual visits would enable providers to see more patients overall and spend more time with folks who actually need in-person care.
And for the disabled or the elderly who might not have full independence, telemedicine is a game changer. Virtual check-ins, especially when coupled with prescription delivery, will help patients stay connected to their care provider without having to arrange for transportation or an appointment companion.
Because Medicare makes up such a large portion of healthcare revenue in the U.S., its slow pace of innovation has been one of the biggest roadblocks to telemedicine growth and consumer adoption. But these new rules suggest that in the CMS’s opinion, telemedicine does add value to the doctor-patient experience and will be a big part of its future.
With public commentary due by September 10, I encourage my colleagues in the healthtech industry, friends in the VC space, and anyone who wants a smarter, faster, more efficient healthcare system to share their opinion with the CMS today.
Joel Wishkovsky is founder and CEO of Simple Contacts.
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