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Telemedicine Takedown; Cue the Copays; Winners for Satisfaction

Welcome to Telehealth Roundup, highlighting news and features about emerging trends in telemedicine and telehealth.

Telemedicine Schemes Bring Federal Charges

The Department of Justice charged 345 people, including more than 100 doctors, nurses, and other licensed medical professionals, in what the agency called its largest healthcare fraud case ever.

Defendants were charged with submitting more than $6 billion in false and fraudulent claims to federal health care programs and private insurers, the justice department said.

The largest amount — $4.5 billion in allegedly false and fraudulent claims submitted by more than 86 criminal defendants in 19 judicial districts — involved telemedicine schemes.

In some cases, business executives paid doctors and nurse practitioners to order unnecessary durable medical equipment, genetic and diagnostic testing, or medications, either without any patient interaction or with only a brief phone conversation with patients they had never met, prosecutors said. Fraudulent claims were submitted to Medicare and other government payers and proceeds laundered through international shell corporations and foreign banks, according to court documents.

CMS’s Center for Program Integrity separately announced that it revoked the Medicare billing privileges of 256 other medical professionals for their involvement in fraudulent telemedicine schemes.

“This nationwide enforcement operation is historic in both its size and scope, alleging billions of dollars in healthcare fraud across the country,” Acting Assistant Attorney General Brian Rabbitt said in a statement. It follows the 2019 Operation Brace Yourself takedown, a $1 billion orthotic brace scheme also involving telemedicine fraud.

Insurers Roll Back Coverage

UnitedHealth Group and Anthem customers may face out-of-pocket charges for certain telehealth visits starting Oct. 1, STAT reported.

Until Sept. 30, UnitedHealth had covered the full cost of telehealth visits with in-network providers at no cost to patients. Now, depending on their benefits plan, some UnitedHealth members will be responsible for copays, coinsurance, and deductibles for virtual medical care not related to COVID-19.

Anthem also will stop waiving the cost of copays, coinsurance, and deductibles for virtual visits not related to COVID-19 as of Oct. 1 for some members.

It’s not clear how much patients will pay for telehealth services or how these costs will compare with in-office visits.

“I think it’s irresponsible to decrease payment for the kind of care that so many patients are receiving,” Adam Licurse, MD, executive director of the virtual care department at Brigham and Women’s Hospital and Faulkner Hospital in Boston, told STAT.

“For many patients, it’s their lifeline right now — it’s the only way that they’re feeling comfortable or safe receiving care.

Potential effects on providers also are concerning, Licurse said: “To have a provider feel financial pressure to offer less telehealth and bring more patients into the office — because they have to pay the bills and keep the lights on and keep their practice running — is a pressure providers shouldn’t have to face.”

Some insurers, including CVS Health and BlueCross BlueShield Tennessee, already have extended their expiration date until the end of this year, and others may follow suit.

Telehealth Patient Satisfaction Surges During Pandemic but Barriers to Access Persist, J.D. Power Finds

Amwell Ranks Highest among Direct-to-Consumer Brands; Cigna Ranks Highest among Health Plans

Telehealth has emerged as one of the bright spots in the “new normal,” giving patients the ability to meet virtually with healthcare providers from the safety and comfort of home. However, the technology is still experiencing growing pains. According to the J.D. Power 2020 U.S. Telehealth Satisfaction Study,SM released today, patient satisfaction with telehealth services has been increasing during the COVID-19 pandemic, but several barriers to access still exist for many patients, including those most at risk.

This press release features multimedia. View the full release here:

J.D. Power 2020 U.S. Telehealth Satisfaction Study (Graphic: Business Wire)

“The COVID-19 pandemic has been a moment of truth for telehealth, and, by most accounts, the technology is rising to the challenge and delivering a high degree of satisfaction among those who use it,” said James Beem, managing director of global healthcare intelligence at J.D. Power. “However, even though the public awareness with Telehealth is higher due to the influence of COVID-19, the barriers for the consumer to engage with the technology has been a consistent theme in our research.”

Following are some key findings of the 2020 study:

  • Great patient experience: The overall customer satisfaction score for telehealth services is 860 (on a 1,000-point scale), which is among the highest of all healthcare, insurance and financial services industry studies conducted by J.D. Power.

  • Barriers to access persist: Though telehealth has been pitched as a solution to improve access to healthcare for everyone, more than half (52%) of telehealth users say they encountered at least one barrier that made it difficult to use telehealth. The most common hurdles are limited services (24%); confusing technology requirements (17%); and lack of awareness of cost (15%). Additionally, 35% of telehealth users indicate they experienced a problem during a visit. Tech audio issues (26%) are the most common problem.

  • At-risk patients have lower levels of satisfaction: Overall satisfaction is 117 points lower among patients with the lowest self-reported health status than among patients who consider themselves to be in excellent health. Similarly, healthier patients are significantly more likely to understand the information provided during the visit, receive clear explanations, feel their visits are highly personalized and obtain a high-quality diagnosis.

  • Safety becomes a top driver of utilization: Among patients who used a telehealth offering this year, 46% say their top reason for choosing telehealth was safety. That compares with just 13% in 2019.

Study Rankings

Amwell ranks highest in telehealth satisfaction among direct-to-consumer brands, with a score of 885. Doctor on Demand (879) ranks second.

Cigna ranks highest among payers of health plan-provided telehealth services with a score of 874. Kaiser Foundation Health Plan (867) ranks second and UnitedHealthcare (865) ranks third.

The J.D. Power U.S. Telehealth Satisfaction Study, now in its second year, measures consumer satisfaction with their telehealth service experience based on four factors (in order of importance): customer service (42%); consultation (28%); enrollment (19%); and billing and