Medicare, Telehealth and congress

Medicare annual spending on Telehealth is around $5M. Compare that number with $505B annual spend for covering about 60 million Americans and you get the idea that Telehealth is not a prevalent service. CMS stipulates allowable originating sites of care  to be where the patient physically is. Like the home which is where most patients end up recovering. It is arguably their preferred place to be. Care can and should be provided where the patient is and it should be cost effective and clinically approved.

At the moment Telehealth is only available to Health Professional Shortage Areas and not in larger metropolitan areas where population is more dense. By eliminating this restriction there will most probably be an overflow of service requests where medical services and consultation could be conducted from the comfort of one’s home.

Currently Telehealth is restricted to voice and video. Congress can aid by expanding and adding other modalities to active monitoring with the use of wearables and sensors. This will require an expansion of CPT and HCPCS codes to actually cover these real time and on going services.

Lastly congress can consolidate states and federal offices in normalizing the licensing process to allow physicians to care for patients beyond their state’s borders. This will elevate demand from physicians in larger and more dense populations and also provide patients with choices.

There are 6 acts under way which are relevant to Telehealth:

Interstate Telehealth licensing

The Federation of State Medical Board (FSMB ) will enable physicians to practice across state lines. This compact was adopted by legislators in Alabama which is the 7th state required to enact it. 11 other states have the act pending approval.

Medicare Telehealth parity act 2015 – H.R.2948

This act discusses the expansion of Telehealth in 3 phases:

Phase 1

Expands what sites qualify as “originating site” to include federal health centers, rural health clinics, and counties in Metropolitan areas with populations less than 50,000.

Include services provided by diabetes educators, respiratory therapists, audiologists, occupational therapists, speech language therapists, and physical therapists.

Phase 1 also provides Medicare coverage of asynchronous (store & forward) Telehealth services across the country (beyond Alaska and Hawaii).

Phase 2

Expands qualifying originating sites to include a “Home Telehealth Site”, to include counties in Metropolitan Areas with populations of 50,000-100,000.

Phase 3

Originating locations definition expanded to include counties in Metropolitan areas with populations above 100,000. CMS is also authorized to develop and implement new payment methods for these services.

ACO improvement act – H.R.5558

An act to improve the ACO model by providing additional incentives based on quality of care and increasing collaboration between patients and physicians. Among the financial incentives for performance, this act includes patient’s option to choose their primary care provider, a nurse practitioner or physician assistant in rural and underserved areas.

Telehealth enhancement act – H.R.3306

This bill and it’s revised 2014 version, will add Medicare home health payments to remote monitoring services and is aim to expand coverage to all critical access and sole community hospitals. It would also cover home-based video services for hospice care, home dialysis and homebound beneficiaries and allows states to set up high-risk pregnancy networks.