Telemedicine Regulation Changes Urged
By Christine Kern, contributing writer
A series of letters push for better accommodation of telehealth and remote patient monitoring.
Three letters have been sent to newly minted HHS Secretary Sylvia Mathews Burwell, pushing potential changes to the ACO program and better accommodation of telehealth and remote patient monitoring. The coordinated series of letters came from industry, trade groups, and ACOS which contend telemedicine has been frustrated by a patchwork of regulations and reimbursement policies hindering adoption.
The three letters focus on several existing telehealth policies which create disincentives for using telehealth. Together, these policies mean “those of us working with providers who do not receive reimbursement for connected care services are faced with the difficult decision of assuming financial risk by providing the care for free. For many physician-led and smaller ACOs without access to a lot of capital, it is not even an option.”
One letter was sent by the Alliance for Connected Care, a lobbyist group which includes such telehealth vendors as WellPoint, Teladoc, CVS, Walgreens, Verizon, HealthSpot, and Welch Allyn as well as a number of disease and healthcare advocacy organizations. Another came from the American Telemedicine Association, HIMSS, Qualcomm, Intel, the Telecommunications Industry Association and a number of other businesses and interest groups. The final letter was signed by the CEOs and Presidents of 29 health systems and ACOs.
Particularly frustrating for the groups are the rules barring reimbursement for “originating sites” outside of rural areas; rules barring “store-and-forward” policies that prevent data from being forwarded to outside services; and a lack of coverage for services in the home or other common medical locations. As Head of HHS, Burwell has the power to waive those restrictions, and the letters indicate optimism that the agency will open a request for comment in the Medicare Shared Savings notice of proposed rulemaking.
The letters contend that encouraging connected care can reduce costs by facilitating coordination of care, and moving care into lower-cost settings – from a hospital to a doctor's office; or preventing emergency care visits. Further, the authors argue, telehealth can reach patients who might not have access to doctors otherwise.
The letters pertain to section 1834(m) of the Social Security Act, a 2001 piece of legislation that was passed at a time when telemedicine was much more of an unknown quantity, and fee-for-service was the main payment model in consideration. The Act restricted CMS reimbursement for telemedicine to rural areas, where it was believed telemedicine had the most cost-saving potential, as well as disallowing coverage for store-and-forward technologies and services like physical therapy and occupational therapy.
Because ACOs use bundled payments, Medicare doesn’t pay for their services per item. Rather, it gives them a lump sum to provide the best care possible. So if something is restricted from coverage, ACOs often have to restrict the service entirely.
“Those of us working with providers who do not receive reimbursement for connected care services are faced with the difficult decision of assuming financial risk by providing the care for free,” says the ACO letter. “For many physician-led and smaller ACOs without access to a lot of capital, it is not even an option.”
The ATA is also pursuing legislative means to get the restrictions removed, via HR3306, a bill currently in the House, proposed by Congressman Gregg Harper (R-MS). Notably, some of the organizations involved had sent a similar letter to former secretary Kathleen Sebelius before she stepped down. Nonetheless, many believe that it is just a matter of time before the restrictions are finally lifted.