Expired telemedicine codes place services in limbo

Billing codes for telemedicine consultations ran out at the beginning of this week.

Cayman Islands healthcare providers are awaiting details from the Health Insurance Commission on how to move forward with telemedicine appointments, after the established billing codes for such services expired on Monday, 27 April.

Dr. Marc Lockhart, chairperson of the Cayman Islands Mental Health Commission, said he had not received communication from the commission on how to proceed, placing financial uncertainty on patients and providers.

“I haven’t received any email or any information about anything being reviewed or any changes,” he said on Monday, when the telemedicine codes expired.

“I’m at work today and I’ve already communicated with about eight or nine people, and life goes on. People are still having challenges. People in our community still have high blood pressure. There’s still people out there with asthma, still people with diabetes. There’s still people with insomnia and stress-related symptoms.”

He expressed concern that billing and access questions could have an adverse effect on quality of life and result in worsening health outcomes.

The Cayman Islands Insurance Association had communicated telemedicine billing codes and procedures with healthcare providers in March, with the understanding that further instructions would be provided before the codes’ expiration date on 27 April.

Dr. Marc Lockhart

The Health Insurance Commission had not provided an update on the codes to the Cayman Compass by press time on Wednesday.

In a 9 April email, the HIC’s Mervyn Conolly said the commission and the Ministry of Health were meeting with health insurance company representatives and medical providers to determine a way forward.

“We will provide an update thereafter,” he said.

The issue remains in the hands of the HIC to resolve, said Annikki Brown of the Cayman Islands Insurance Association.

“Where the discussions ended has been that the codes and coverage are in the hands of the HIC to change,” she said. “At the moment, the intention is to continue as we are.”

Lockhart said the telemedicine codes, limited to 15-, 20- or 30-minute sessions, were never sufficient for practitioners, especially those working in mental and behavioural health.

“The problem is that most or a large percentage of medical and counselling and psychological services require a minimum of 30 minutes,” he said.

“For new patients and assessments, it’s a minimum of 60 and sometimes up to 90 minutes, and that’s because time is required to obtain information, to review documentation, to receive collateral information from parents and caregivers, and also then to spend time with the actual patient themselves to do our assessment.”

The situation puts providers in a difficult situation, he said, as they seek to provide quality, consistent care while also working to keep their virtual doors open and staff paid.

“That now puts all of us in a tough spot. And when I say all of us, I’m not just talking about the providers, but our patients and the community because we are now in a public health crisis.”

Meanwhile, health practitioners are working to encourage patients to reach out when they need assistance and to avoid putting off medical care.

“We, the healthcare providers, understand how stressful these uncertain times are. We want you to know that our priority is to provide uninterrupted and high-quality medical care to our patients and the broader community,” reads a statement from the Cayman Islands Medical and Dental Society sent 22 April.

“To ensure the ongoing provision of quality healthcare, while limiting your risk of exposure and the spread of the virus, we have decided to launch TeleMedicine visits. This means we will provide you with the means to communicate with us so we can address your needs, without an in-person visit.”

The reality behind the scenes for healthcare providers has been uncertain, however.

To ensure continuity of services, Lockhart said he has had to review his billing scheme and offer discounts to patients. He said that while he understands concerns about practitioners potentially taking advantage of telemedicine codes to overcharge, he hopes a compromise can be made.

“The bad actors are not just physicians that are going to take advantage of this, but insurance companies also have been known to take advantage of situations or to not cover people when they should be covered for certain issues,” he said.

“We can meet halfway. We’re not asking to open everything up completely. We’re just saying, let us look at coming up with a mutually agreeable, appropriate coding system to address this current period of time.”

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