Insurance coverage

Teleophthalmology is here today, but insurance coverage and reimbursement will change

Insurance reimbursement for teleophthalmology services is not consistent across populations and has only recently received a boost due to flexibilities allowed during the pandemic, said Parisa Emami-Naeni, MD, MPH, professor assistant ophthalmologist at the University of California, Davis, and vitreoretinal surgeon and uveitis specialist at the UC Davis Eye Center.

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Your study of remote retinal imaging during the pandemic found “inconsistent insurance coverage for teleophthalmology services.” Can you explain what this means?

We performed regression analysis and adjusted for all baseline beneficiary characteristics, and found that insurance reimbursement for teleophthalmology services was lower among older people—those aged 65 and older— beneficiaries of Medicare Advantage plans, enrollees with lower household income, and African American individuals. We were interested in this because many of these people, such as seniors or racial minorities, are the ones who benefit the most from these services. And the decline in reimbursement for services among these people means that these beneficiaries cannot use these services as often as other beneficiaries or other enrollees.

By the end of 2020, insurance coverage for remote retinal imaging had largely returned to pre-pandemic levels. When the public health emergency ends, do you expect a further drop?

Early in the pandemic, many telehealth restrictions were lifted to encourage social distancing and reduce the number of non-essential in-person medical visits. However, many of these changes are temporary and will likely end later this year and after the end of the public health emergency, or PHE period, although a 151-day post-PHE extension was recently instituted on many numerous telehealth flexibilities.

With the recent advances in teleophthalmology and remote eye screening for people with diabetes and with the improvement in the quality of the cameras we have, as well as with the advances in artificial intelligence in reading these images, the teleophthalmology is here to stay. But we’ll have to wait and see how insurance coverage and reimbursements evolve over time.

I would like to thank my collaborator and partner in crime in this study, Dr. Glenn Yiu, who is a vitreoretinal surgeon at UC Davis. He is also the director of teleophthalmology services at UC Davis.