Nebraska hospitals raise concerns about cuts to telehealth payments | Health & Fitness

OMAHA — The Nebraska Hospital Association is raising concerns on behalf of its members about recent cuts by Blue Cross Blue Shield of Nebraska to the amount it pays providers for medical telehealth visits. 

Jeremy Nordquist, the association’s president, said Blue Cross now is paying providers of medical telehealth visits half of what the insurer pays for in-office medical visits. The reduction in payments came in some of the new agreements between the insurer and hospitals that went into effect July 1. 

“It’s a devastating cut, it’s a shortsighted cut that will really put an end to telehealth in Nebraska if that’s the direction payers are going to go,” he said Tuesday. 

Blue Cross officials said in a statement Tuesday that the new reimbursement rate still is at or above pre-pandemic reimbursement rates. Blue Cross is not the only carrier in the industry making such reimbursement adjustments now that the pandemic has eased, the officials said.

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In the early days of the pandemic, Blue Cross voluntarily expanded payment of telehealth services so people could get the care they needed. In March 2020, telehealth usage shot up more than 1,000% over February 2020 numbers.

Although telehealth usage remains higher than pre-pandemic figures, it has continued to steadily decrease — about 30% year over year — since the peak in early 2020, according to the insurer’s statement. As vaccines have become widely available and the number and severity of cases has decreased, most people have returned to pre-pandemic activities, including in-person visits with their providers.

But Nordquist said many providers won’t be able to afford to offer telehealth medical care at the lower rate. Analyses by organization staff and conversations with hospital officials indicate that the costs for providers with brick-and-mortar facilities to deliver telehealth visits aren’t much different from the costs of offering in-person visits. Providers’ time commitment is pretty much the same for both types of visits, he said.

While some of the state’s larger health systems have offered inexpensive telehealth visits, particularly during the pandemic, Nordquist said he is hearing that the cost equation may cause some to reconsider some of those offerings. 

Nebraska does have a law, adopted in 2021, that requires that reimbursements for behavioral health telehealth visits be the same as for in-person behavioral health visits.

But a similar measure, LB314, that would have required parity in reimbursements for medical visits did not advance, Nordquist said. At that time, Blue Cross officials told legislators they had no plans to pull back from their telehealth payment parity position because they thought it met the needs of the market.

In 1999, Nordquist said, the Nebraska Legislature adopted a law requiring payment parity within the state’s Medicaid program. At the national level, Medicare still pays providers at the same rate for telehealth and in-person visits, although that is an administrative policy that is subject to change.

Nordquist said the people who will suffer most if telehealth were limited in the state are rural residents who drive many hours to see specialists and people in urban settings who face transportation challenges. During the 2021 parity bill hearings, Omaha endocrinologists testified that they were successfully treating diabetes in patients around the state.  

“Really, telehealth is about convenience and getting people access to care when they need it,” Nordquist said.

On a recent call, he said, United HealthCare officials told him that they had no plans to move away from parity in payments.

The hospital association, he said, will seek to persuade insurers to revisit medical telehealth parity during the next legislative session. Nordquist said he is confident new legislation will be introduced. He said he thinks the impetus will come from rural senators who have seen telehealth expand access to care in their districts.