FutureFocus February 28, 2018: TrendTracking New Telehealth Reimbursement and Future Services

Lisa Remington

In this week’s FutureFocus, we TrendTrack new telehealth reimbursement and future services. In 2017, there were 210 telehealth related bills. Telehealth is finally finding its place in the healthcare delivery system. In another article, we provide insights into health care spending.  In 2020, home health is projected to be the fastest growing sector at 6.7 percent annually, from 5.1 percent in 2017.

Lisa Remington, President, Remington Health Strategy Group

New rules to encourage use of telehealth services under Medicare is a priority at the Centers for Medicare & Medicaid Services (CMS), Administrator Seema Verma told the National Rural Health Association's Policy Institute meeting in Washington. “This year you are going to see a lot more from us in our payment rules,” in particular addressing the health needs of underserved areas.

"We are bringing a rural health lens to all of CMS' programs and policies," Verma added at the group’s February 6-8 meeting to lobby Congress on behalf of issues of concern to rural health care providers.

Verma has long been interested in expanding use of technology in underserved areas. During her Senate confirmation process in March 2017, Verma told the Senate Finance Committee she wanted to promote technology’s use and would work with Congress to bring that about. “Telehealth can provide innovative means of making healthcare more flexible and patient-centric. Innovation within the telehealth space could help to expand access within rural and underserved areas.”

In addition to CMS’ considering new telehealth services through regulation, Congress has the Medicare Payment Advisory Commission (MedPAC) studying potential legislation.

MedPAC Considers Ways to Evaluate New Telehealth

Within the 21st Century Cures Act of 2016, MedPAC must provide information to the congressional committees of jurisdiction that identifies:

  • The telehealth services for which payment can be made, under the fee-for-service program under Medicare Parts A and B;
  • The telehealth services for which payment can be made under private health insurance plans; and,
  • Ways in which telehealth services covered under private insurance plans might be incorporated into the Medicare fee-for-service program (including any recommendations for ways to accomplish this incorporation).

The report is due by March 15, 2018. MedPAC is Congress’ chief advisory body on Medicare policy.

"Between 2014 and 2016, the number of telehealth visits per 1,000 beneficiaries increased 79 percent among Medicare beneficiaries."

At MedPAC’s January meeting in Washington, Commission staff briefed members on report draft language subject to revision. Staff noted that while use was low, the growth in telehealth use has been rapid. Between 2014 and 2016, the number of telehealth visits per 1,000 beneficiaries increased 79 percent among Medicare beneficiaries. The most rapidly growing services were for subsequent nursing care, psychotherapy, and pharmacy management. “Keep in mind that one factor in this rapid growth is that the base use in 2014 was extremely low.”

Staff research also found that under risk-bearing entities such as MA and ACOs, “flexible coverage of telehealth exists. Lastly, we found that Medicare coverage of telehealth is most constrained under the physician fee schedule and is the focus of the mandated report.”

Staff presented a draft Commission recommendation, subject to revision in the report: “In an effort to simultaneously exercise caution and advance the Medicare program, the Commission recommends that policymakers use the following three principles to guide the evaluation of individual telehealth services for their potential incorporation into the program. While a given telehealth service may not demonstrate evidence of all three principles, a service should strike a balance between these three.

“The first principle is reducing costs, the second principle is expanding access, and the third principle is improving the quality of care. When telehealth services demonstrate evidence of balancing these principles, policymakers could consider incorporating them. When the evidence is unclear, policymakers could consider testing the service more thoroughly through CMMI.”

As examples of potential expansion, the Commission discussed telestroke and tele-mental services. Telestroke services are currently covered by the fee schedule in rural areas, but policymakers could consider expanding to urban areas. Tele-mental health services, which are currently covered under the fee schedule in rural areas, but policymakers similarly could consider to expand these services to urban areas or to the patient's residence.

See additional information on the expansion of telehealth.

By: Ronald M. Schwartz, Writier, The Remington Report