Despite the possibilities, general usage of telemedicine stays low among physicians. Less than 1% of physicians accounted for 22 percent of telemedicine visits in 2014, according to MedPAC. Only two percent of people had participated in a telemedicine consult, and just 69,000 people used telemedicine in 2014. Among public and private entities, the Department of Veterans Affairs, which supports remote consults by both lowering or waiving copayments, records among the best rates of telehealth use. In the past decade 736,000 veterans used such options, mainly for primary-care consults, long term care management and transmission of imaging or alternate patient data.

Some commissioners were worried that raising Medicare payment for such options would increase cost significantly without noticeably improving quality of care. More study is needed to determine the value of telemedicine in primary care, some commissioners said, although they acknowledged that more extensive adoption may decrease hospital and ER admissions. Medicare handles a limited set of telemedicine options with a facility fee to rural sites and full fee schedule payment for people who reside in designated medical specialist deficit regions. Jon Christianson, Ph.D., vice-chairman of MedPAC, said some company insurance agencies bill a high co-payment for telemedicine to discourage its use.

Other commissioners expressed the opposite view, noting that investment in such technology could decrease less cost-effective solutions like hospital visits, ER visits and imaging costs. If telehealth checks some of the costs, the slow escalation in telemedicine can be good, said Craig Samitt, M.D., M.B.A. I think we are being overly conservative. We should be embracing the use of technology faster in the marketplace. Our payment system should not suppress progress.