By: Lisa Remington, President, Remington Health Strategy Group, Publisher, The Remington Report
Policy is now moving the needle closer to expanding telehealth (remote monitoring) as a key technology to innovate and drive better results for patient care. It’s happening across the continuum with Physicians, Payors and home health providers.
Home Health and Telehealth Got Its Roots in 1879
In an article, “The Evolution of Telehealth: Where Have We Been and Where Are We Going? (Institute of Medicine 2012), we learn just how far back telehealth goes. Health care in the home-based setting has a long history. For example, an 1879 article in the Lancet talked about using the telephone to reduce unnecessary office visits. In 1925, a cover of Science and Invention magazine showed a doctor diagnosing a patient by radio, and within envisioned a device that would allow for the video examination of a patient over distance. Home monitoring developed more fully in the Mercury space program when the National Aeronautics and Space Administration (NASA) began performing physiologic monitoring over a distance. NASA further developed this technology with a pilot with the Papago Indians, the Space Technology Applied to Rural Papago Advanced Health Care (STARPAHC) project.
Are we really talking more than a hundred years ago that the idea of telehealth was around? It’s been a long and windy road, but policy now is advancing telehealth quickly.
"CMS proposes the cost of remote patient monitoring to be included as an allowable administrative cost. "This will allow home health agency payment to reflect their use of innovative technology," said Verma."
I can’t help but go back to my first experiences with home-based telehealth in the 1990’s. The national news picked-up the story about “Hank.” Hank was a big metal box that sat at the bedside of patient’s in their homes. Imagine this rather awkward big metal box sitting on the side of a patient’s bed asking in his robotic voice: “How can I help you.” Of course, back then, people responded with a laugh never seeing the likes of anything like it. But, Hank paved the way to where we are today. We’ve come a long way!
Ok. So now it looks like we are moving into the 21st century recognizing telehealth as a supportive technology for better patient care. Changes in policy will finally move the needle into value-based care initiatives supporting better patient-centered care.
Home Health Agencies
Under the proposed Medicare payment updates for 2019, home health agencies (HHAs) will be allowed the cost of remote patient monitoring to be reported on the Medicare cost report.
In a statement last week, CMS Administrator Seema Verma said more use of remote monitoring would allow doctors more time with their patients. At the same time, home health agencies would be able to leverage innovation to drive better results. CMS proposes the cost of remote patient monitoring to be included as an allowable administrative cost. "This will allow home health agency payment to reflect their use of innovative technology," said Verma.
In 2016, about 3.4 million Medicare beneficiaries received home health services. The program spent about $18.1 billion on home healthcare services and more than 12,200 agencies participated in Medicare, according to the Medicare Payment Advisory Commission.
Starting January 1, 2018, Medicare began covering remote monitoring of patients with one or more chronic conditions.
Buried in the 1,653-page 2018 Physician Fee Schedule rule issued on November 2, the following codes to the list of covered telehealth services:
- HCPCS code G0506 for chronic disease management care planning
- HCPCS code G0296 for a visit to determine low dose computed tomography eligibility
- CPT code 90785 for interactive complexity
- CPT codes 96160 and 96161 for health risk assessments
- CPT codes 90839 and 90840 for crisis psychotherapy
The new benefit, called Remote Patient Monitoring, will provide Medicare beneficiaries the choice to receive in-home monitoring in addition to traditional check-ups in clinics, doctor’s offices and hospitals.
Chronic Care Act
The two-year budget deal, approved by Congress in February includes parts of the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act. The Act targets Medicare’s telehealth and telemedicine reimbursement rules.
The new law expands across the healthcare continuum:
- eliminates geographic restrictions on telestroke consultation services, beginning in 2019 called FAST (Furthering Access to Stroke Telemedicine ) Act;
- expands telehealth coverage under Medicare Advantage Plan B, beginning in 2020;
- gives Accountable Care Organizations more flexibility to use telehealth services;
- adds the patient’s home freestanding dialysis facilities, without geographic restriction, to the list of originating sites for monthly telehealth assessments with a nephrologist, beginning in 2019, though Medicare would not provide a separate originating site payment if the service was conducted at home; and
Look forward to more announcements connecting telehealth reimbursement to behavioral health and Medicaid.