Reimbursement for telehealth initiatives remains an uncertainty in the United States today, with capitated systems at the forefront in initial teleglaucoma applications.
Reviewed by Siddarth Rathi, MD, MBA
Worldwide, healthcare systems are implementing models of teleglaucoma care. Clarifying reimbursement considerations, however, is necessary for greater strides toward U.S. adoption, according to Siddarth Rathi, MD, MBA, assistant professor of ophthalmology at NYU Department of Ophthalmology. Dr. Rathi noted some examples for consideration.
The University of Alberta’s teleglaucoma program consists of a remote or in-house pathway, he noted. Patients on the remote pathway visit a local ophthalmologist or optometrist who collects standardized history, examination, and imaging findings.
The eye-care provider securely transmits the information to a remote glaucoma specialist who delivers an electronic recommendation to the referring clinician. The in-house program is a tertiary-care referral center in Edmonton.
These individuals see an ophthalmic technician who obtains the history, exam, and imaging, according to Dr. Rathi. A glaucoma specialist reviews the data and sends a report to the referring provider. The program seeks to reduce the time patients spend in the clinic, and wait to have a glaucoma evaluation. In Canada, Medicare reimburses at two-thirds of the conventional in-person fee for these consultations.
At the Lions Outback Vision Center in Australia, the patient sees a local optometrist who sends the history, exam findings, and imaging to the remote ophthalmologist. Dr. Rathi said that the specialist video conferences with the patient and the local provider to deliver the recommendations.
Australia Medicare reimburses clinicians if there is a live audio-video component to the encounter and the patient is located at least 15 kilometers away from the consulting ophthalmologist or resides in a care facility for indigenous Australians.
“Initially, there was no reimbursement for the local referring optometrist,” Dr. Rathi said, “After Medicare implemented reimbursement covering technical costs for the referring physician, the program had a 3.5-fold increase in utilization during the next 12 months.”
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Siddarth Rathi, MD, MBA
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This article was adapted from Dr. Rathi’s presentation at the 2019 American Glaucoma Society annual meeting. He has no financial interest in any aspect of this report.