Payers See Longer-Term Role for Telehealth in Eyecare

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NEW YORK—Managed vision care plans, across the board, are reporting greater interest and demand for telehealth options from both patients and providers. As ODs began using ocular telehealth more frequently in March as COVID-19 spread, there were also mounting questions and concerns among ECPs about how these new telehealth technologies would fit in with the policies of managed vision plans.

The reaction among the leading vision care plans was to review their policies and consider where and how changes could be made to help everyone best adapt to this “new normal” in eyecare. Vision Monday spoke with managed vision executives to gauge their sentiments about telehealth, now and in the future.

“Telehealth has moved dramatically across really every kind of medical specialty and medical modality, not just vision care,” UnitedHealthcare Vision general manager John Ryan told Vision Monday in an interview.





As a result of the COVID-19 pandemic, UHC and other vision care plans, have set up and published coding information that provider networks can utilize to handle consults with remote patients. “We saw the industry move from something that some [providers] were doing or talking about, on an emergent basis, to something that they very much wanted to be part of within their practice,” Ryan added. “From the UnitedHealthcare perspective, and really the UnitedHealthcare Group’s, we embraced telemedicine across all sorts of spectrums. I don’t see that curtailing, and not just because the coronavirus will probably be here for some time.”

Dr. Scott Edmonds, a vice president at UnitedHealthcare Vision, noted that UHC has in the past looked at “all kinds of telemedicine solutions and artificial intelligence options” and considered how they might integrate with eyecare practices. “I always went back to my practice and didn’t really see a role for it in what I did day-to-day,” he noted. “With COVID, all of a sudden the dynamics changed.”

In addition to publishing new coding to connect with eyecare partners, UHC worked to help ECPs understand the coding they could use if they submitted through their normal claims’ processes, Ryan said. “We reprogrammed our systems to accept those codes and it was in response to COVID. But my planning at this point as the general manager of United Healthcare Vision is that we will absolutely continue this. … It will be interesting for us an industry to see what the utilization of this is, including how it changes as people move back into a more typical pattern. But our supposition is that [telehealth] will become part of our claims’ submission practices and part of the providers’ normal modalities.”

Under its current reimbursement procedures, UHC Vision plans offer the same benefit coverage and provider reimbursement rates for in-person services and care provided via telehealth technology. All eyecare services – regardless of setting – are held to the same quality and practice standards. In addition:

• Evaluation and management codes are covered by a limited number of vision plans.

• With respect to services that include CPT codes 92227 and 92228 (remote retinal imaging services), UHC Vision said these codes are covered by a limited number of plans.

• With respect to interprofessional telephone/internet assessment and management services, UHC Vision plans do not offer coverage for codes 99446-99449 or 99451-99452, which represent doctor-to-doctor consultations.


VSP: Keeping the Doctor Involved

VSP Vision Care also has taken steps to adapt to the changing landscape for telehealth. At the beginning of COVID, VSP expanded emergency and medical eye care services for VSP members throughout April and May. At that time, Premier Academy360 also started to roll out free webinars for all VSP network practices on a variety of relevant topics, including telemedicine. A hub of telemedicine resources for practices now available can be found here: www.vspproviderhub.com/telemedicine.html





“Telemedicine has historically been a sensitive topic in eyecare, but throughout COVID-19, it has provided an important solution to safely increase access to care and keep patients and doctors connected virtually during the pandemic,” Mary Anne Murphy, OD, vice chair of VSP Global’s board of directors, said in a statement. “VSP’s position has consistently maintained that telemedicine should always have a doctor involved.”

Given the COVID-19 environment, VSP network doctors can now update their profile on the VSP Find a Doctor directory to include an indicator if they offer eyecare services through telemedicine.

Under its current reimbursement procedures, VSP reimburses providers for appropriate medical eyecare services delivered via telehealth channels, but does not cover remote refractive routine eye exams. In addition:

• VSP reimburses providers for medical eyecare services delivered via telehealth channels, including specific Evaluation & Management CPT codes (99201-99205, 99211-99215, 99421-99423) covered under the Primary EyeCare Plan and Diabetic Eyecare Plus Program.

• In addition to specific Evaluation & Management CPT codes, services include CPT codes 92227 and 92228 (remote retinal imaging services) covered under the Primary EyeCare Plan and Diabetic Eyecare Plus Program.

• VSP also covers interprofessional telephone/internet assessment and management services.

Murphy added, “VSP continues to evaluate solutions that can help increase access to care for remote or underserved communities, strengthen the doctor-patient relationship, and meet the demands of consumers and VSP Vision Care clients.”






EyeMed: Protecting the Member Experience
EyeMed, the managed vision care plan owned by Luxottica, is currently evaluating several telemedicine platforms “to determine whether they can be used to provide a comprehensive eye examination consistent with the same standard of care as an in-person examination,” EyeMed president Lukas Ruecker said in a statement. “Based on the results of those evaluations a policy regarding the delivery of covered services through telemedicine is expected later this year.”

EyeMed, at this time, covers medical telemedicine consults under its medical / surgical plans.

Ruecker noted EyeMed is supportive of telemedicine if it is in support of the provider, meets a standard for quality of care, and meets member expectations. He added, “Telemedicine is filled with complexity – as all consumer health topics are - and its many layers are being peeled back now in real time, particularly in light of COVID.”

In addition, EyeMed is working at the NAVCP level to develop a policy for remote comprehensive exams that will allow the industry to adapt this new technology in “a manner that preserves and protects member experiences and the quality of the service they are getting,” Ruecker said.


Versant Health: Telemedicine’s Enhanced Role
Versant Health (owner of Davis and Superior Vision) noted in comments to Vision Monday that it is complying with federal and state mandates related to the expansion of allowed telemedicine services and modes of delivery. (The requirements vary state by state and market segments, i.e. Medicare, Medicaid and commercial).

Versant Health maintained a robust telemedicine policy, prior to the coronavirus pandemic, the vision plan noted, and said it will “continue to monitor the telemedicine landscape and review utilization trends which will help guide any decisions to expand our current policy, outside the current mandates.”

Versant also noted that it has observed a “significant increase in medical vision services being rendered via telemedicine since mid-March 2020.”

The company added, “Versant Health understands and supports the enhanced role of telemedicine in the future. By the nature of an eye exam being a close face-to-face encounter between provider and patient, telemedicine offers patients who wish, and who are able, an alternative to a face-to-face examination. Versant Health will continue to support our eyecare professionals in their use of telemedicine, as long as telemedicine services are rendered adhering to all federal and state requirements and/or restrictions.”