Calling all my friends on this forum who are in Michigan- BCBSM is pulling back their support of telemedicine as of July 1. Below is the email I crafted that I am sharing with anyone who I think will listen- the governor, Congressional representatives, state representatives, MSMS, BCBS, journalists, etc.
I am asking for everyone’s help to try to convince BCBSM to follow the lead of BCBS of Arizona and Georgia who have extended their temporary measures regarding telemedicine (not sure that this list is exhaustive- just the ones I know about).
My name is Misha Moore from Green Tree Pediatrics in Chelsea and Michigan. I am concerned that BCBS is pulling back support of telemedicine services as of July 1. The timing seems so wrong when we have made so much progress in Michigan to be able to reopen and re-engage.
Attached is the document from BCBS announcing the end of their temporary expansion of support for telemedicine that they had put in place to help physicians keep patients out of the office and ensure safe access to care. Not only will cost sharing begin on July 1, but not everyone had access to telemedicine services in their policies before COVID, which means that visits will not be covered if services are provided as telemedicine visits.
During this time, we never closed, we never stopped caring for our patients; we pivoted quickly to telemedicine and worked to create safe spaces in which we could provide Well baby care and immunizations.
I am happy to answer any questions, as well as share our story and perspective. My cell phone is 734-972-9166.
I contacted a few medical directors at BCBSM whose email addresses I have, Governor Whitmer’s office, the offices of both state and federal representatives, a journalist who interviewed our practice last month , contacts at Michigan State Medical Society, and the state AAP chapter’s committee on pediatric advocacy.
I am not an expert in advocacy but trying to learn from the lessons of the PMI Forum webinars- I would say cast your net as wide as you can based on who you know- if you belong to a PO, your provider rep for BCBS, anyone you know at BCBS, anyone who represents you in state or federal government, your local news outlet, Michigan State Medical Society, MI AAP chapter, etc!
Here are some more talking points I developed when we were corresponding with the MI AAP:
The Employer issue - for the large self-insured employers, yes, some of them have chosen to exclude reimbursement for telemedicine- advocacy there is better aimed at our families to put pressure on their employers, especially when those employers are large health systems like Trinity or Michigan Medicine.
Excluding the self-insured employers BCBSM determines the coverage for everyone else - this group needs to be the focus of our direct advocacy with BCBSM.
There are a couple aspects to payer telemedicine policies:
parity of reimbursement whether service is furnished in person or remotely
cost-sharing for telemedicine
what telemedicine looks like in the context of PCMH- everyone is tired of having to fix (for free) all the bad medicine delivered through “urgent care” style telemedicine companies
whether the provider and/or patient are located within the state of Michigan at the time of service
requirement of HIPAA-compliant platforms
Is BCBS committed to primary care in general and to independent practices specifically? We have been asked to provide free, uncompensated care through nurse calls for too long. Does BCBS want to be even more reliant on the hospital systems because they will be if their reimbursement policies drive us out of business.
This is a huge public safety issue- COVID-19 has not been eradicated; there is no cure; there is no vaccine; all we have is social distancing. This is not the time to pull back from the strategies that allow us to keep patients at home and keep our offices as safe as possible. We need the public to trust that they can safely bring their children to our offices- being able to tell our patients that we are keeping sick patients out of the office as much as we can will help convince them to bring their children in for Well Visit and vaccines.
Attached is the AAP Advocacy roadmap , which includes advocacy for “expanded access and adequate payment for telehealth services” Here is an excerpt:
“To facilitate and expedite the uptake and spread of telehealth care while retaining appropriate linkages to the pediatric medical home, the AAP is advocating that all payers (private payers as well state Medicaid/Children’s Health Insurance Programs (CHIP) and their contracted managed care organizations (MCOs)) should take steps to reduce or eliminate barriers to telehealth care. Nationally, emergency policy changes to telehealth benefits and payment in the Medicare program can serve as a model: expanded coverage of telehealth services beyond patients in rural areas, coverage of services in patients’ homes, waiving cost-sharing, and allowing telehealth via a wide range of communication channels including FaceTime, Skype, Facebook Messenger, Google Hangouts Video, and others.” (p. 5)
BCBSM has been an important partner in promoting the principles of PCMH throughout the state- we do not understand why BCBSM would be backing away at this critical time when our community is still in danger from supporting PCMH-practices to deliver the right care in the right way. Having been such a leader, why would BCBSM fall behind BCBS of Tennessee who has made telehealth reimbursement permanent, or BCBS of Arizona who has extended telemedicine support through July 31, or BCBS of Georgia who has extended to September 13.
Telemedicine is an important triage tool; it creates better after hours access that can keep patients in their PCMH and out of urgent care; it increases compliance for patients who don’t want to travel to and from a clinic. It does not replace the need for in person visits, but it is a powerful tool.
Telemedicine can serve as an antidote to provider burnout , which is partially caused by the anguish pediatricians feel when they are not able to use the best available tools to give the right care to their patients.
Update to BCBS policy in Michigan-- MESSA (school teachers) has extended cost share waiver for telemedicine through the end of the year for its members! This was announced yesterday (July 16)
Thank you @jmc for that suggestion! Definitely, telemedicine in the context of the medical home is an important piece of the story to tell about the value of telemedicine services.
