Video doctor visits have the potential to help many different kinds of patients, but elderly patients, who are sometimes homebound or have trouble driving, would seem like a natural fit -- including the more than 50 million Americans on Medicare. However, according to a new report from Kaiser Health News, fewer than 1 percent of Medicare beneficiaries use video visit technology, owing mostly to a law that continues to rule it out for most, despite the cost savings potential.

According to the report, the only Medicare plans that can offer telehealth to a broad swath of their population are Medicare Advantage plans and Medicare ACOs (the latter were only given that freedom last March by HHS). The rest of Medicare is restricted by law to only offering telehealth services to patients in rural areas, and then only if the patients come in to a clinic. Only two Medicare Advantage insurers elect to offer video visits: Anthem and a University of Pittsburgh Medical Center health plan in western Pennsylvania.

While some state medical boards, made up of practicing physicians, have an economic objection to telemedicine, it's harder to see what the federal government has to gain from restricting its use. According to the KHN report, the justification from the Congressional Budget Office is somewhat bizarre: that while telemedicine might reduce costs on a per-visit basis, they could encourage Medicare beneficiaries to seek more episodes of care, raising costs overall. Dr. Ateev Mehrotra, a Rand Corporation analyst, explained it in a testimony last year before the House Energy and Commerce subcommittee.

"We and others have documented that telehealth and other innovations can be cheaper than an in-person visit on a per visit basis," he said. "However, lower cost per visit does not ensure telehealth will reduce costs. To reduce health care costs, telehealth options must replace in-person visits. The concern is that telehealth could increase costs by driving greater utilization of health care services. In other words, people who otherwise would not have sought care in the first place will use telehealth to get care. If this increased access and greater utilization leads to treatment that leads to improved health, then this new utilization is good for our society. If, however, this new use is overutilization, care that does not lead to improvements in health, then there could be increased costs without any added health benefits. The very advantage of telehealth, its ability to make care convenient, is also potentially its Achilles’ heel. Telehealth may be 'too convenient.'"

MobiHealthNews has covered various bills that have sought to open the door to Medicare telehealth reimbursement, but they have yet to gain traction. An effort by Rep. Mike Thompson, the The Telehealth Promotion Act of 2012, tried to amend the Social Security Act to assert that telehealth must be covered in any case in which the corresponding in-person treatment would be covered. That bill died in committee. Another bill, called the Medicare Telehealth Parity Act of 2014, was introduced last summer. That bill was more measured, expanding the reach of Medicare in telehealth slowly over four years and establishing efficacy data requirements along the way. Provisions to expand Medicare coverage of telemedicine were included in the comprehensive 21st Century Cures legislation in the current Congress, but were dropped in mid-April according to a report over at Modern Healthcare.