Reimbursement Disparity: What works for general telehealth is illogical for teledermatology

With the dramatic need for telehealth in the last few months, the Centers for Medicare and Medicaid Services (CMS), along with private payers, did a commendable job in increasing access and reducing the restrictions on telehealth. This expanded access to care undoubtedly saved lives by maintaining the ability for patients to continue to receive access to routine and acute care, while reducing the spread of COVID-19 by limiting face-to-face visits.

While this quick action is admirable, there is now an opportunity to rectify some of the nuances in policy when it comes to specialties like dermatology. Dermatology, as a highly visual specialty, has specific needs that differ from primary care - particularly the need for high-quality photos to evaluate patient concerns. This is not properly incentivized by reimbursement policies today.

While CMS has temporarily expanded coverage for telehealth appointments to allow for reimbursement parity with in-office visits, this reimbursement is reliant upon a real-time video conference between patient and provider. Focusing on this real-time interaction that most closely resembles an office visit makes sense. It allows doctors and patients to discuss concerns, provide a diagnosis, discuss treatment, and answer questions. This is a key part of most medical evaluations.

What does not make sense is the reimbursement rates for store-and-forward information. Currently, reimbursement rates for store-and-forward photos are so low that in a conversation with Dr. John Kelly, a dermatologist in Rhode Island who specializes in medical and surgical dermatology, he stated, “Proper still photos provide great detail, but email communication is difficult to address all the patient’s concerns and the current CPT codes under-value my time and expertise. I will use store-and forward for the better image quality, but finish my consults using video conferencing so I can ensure patient satisfaction with our interaction, and I am then reimbursed appropriately for the evaluation and management services I provide.”

Most dermatologists I have spoken with concur. Reimbursement leads them to video-conferencing appointments, but accurate diagnosis is vastly improved with store-and-forward high-quality images from patients. Dr. Clifford Perlis, an expert in Mohs surgery, shared that, “Diagnosis is totally different if you can see photos or if you cannot. If you cannot, you are giving more generalized advice and more likely to require follow-up appointments. High-quality images, however, can really allow for a proper diagnosis.”

By adding the ability for doctors to be reimbursed for high-quality store-and-forward images, CMS has the opportunity to achieve a few goals all at once:

  1. Reduce multiple appointments for the same concern
  2. Improve patient outcomes by improving diagnoses
  3. Properly reimburse and providers to use all available technology to improve the care patients receive

I believe it is time for CMS to evaluate the case for reimbursing store-and-forward in conjunction with real-time video conferencing to improve patient outcomes in dermatology.