by Audrey Kinsella
Reimbursement for telehealth services took one step closer to reality recently but there are many more steps to go before home health providers can start counting their money. In April, Orrin Hatch (R-UT) introduced Senate Bill 870 "Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2017" (CHRONIC). It has been referred to the Senate Finance Committee; passage and reconciliation with any future House version is well into the future.
In the 20+ years I have been following home telehealth — its uses, technical variations, and reimbursement stipulations as interpreted by CMS — I have seen uncertainty expressed within the healthcare at home industry about the value of home telehealth. There are two most-asked questions by potential users of home telehealth: Does it work?; and Does Medicare pay for it?
As for the first question, many years of pilot demonstration studies of home telehealth vital sign tracking use have produced ample evidence that remote patient monitoring supports excellent patient health outcomes. These results were obtained over recent decades particularly with congestive heart failure patients. These studies have consistently produced a resounding “yes” to question #1.
Now, about question 2. The Hatch bill, CHRONIC, means that the answer to "Does Medicare pay for telehealth?" is slightly more promising today than it was as recently as March. Rather than "no," it has moved up a notch to "not yet but possibly soon."
Promise of Home Telehealth Reimbursement
Not that soon, though! And do not get distracted by less thoughtful reporting. One article in a popular health magazine, for example, was titled, "Legislation that Would Expand Telehealth Use, Access Passes Easily in Senate Committee." The author intimates reimbursement may be imminent because the bill was passed unanimously, but skips the detail that that was a committee vote. SB 870 still must pass through the entire Senate, then wait to see what the House does. Reimbursement is not a given yet.
What’s more, even if it becomes law, the bill does not provide for covering all telehealth services. Priority is given to costly, specialized uses such as tele-assisted home dialysis treatments and telehealth interventions for stroke patients. When these conditions are treated in conventional clinical settings, they are among the most costly for patients and for Medicare.
Co-sponsor Ron Wyden (D-OR) helped pass SB-870 through the Finance Committee. He noted:
"The CHRONIC Care Act will mean more care at home and less in institutions. It’ll expand the use of life-saving technology. It places a stronger focus on primary care. It gives seniors, however they get Medicare, more tools and options to receive care specifically targeted to address their chronic illnesses and keep them healthy. Those are all important steps forward in updating the Medicare guarantee."
Will we one day soon have targeted, convenient care for seniors, if and when the bill passes? Despite CMS's long history of refusing to reimburse home telehealth services, there is one development in this bill’s favor. The Congressional Budget Office scored the bill and determined that use of home telehealth will reduce healthcare costs and provide direct savings to CMS. Optimism is on display in the member blog pages of the American Telemedicine Association. (https://thesource.americantelemed.org/blogs/jessica-washington/2017/05/18/cbo-greenlights-expanded-medicare-coverage-of-telehealth)
The ATA itself noted "this is the first time that CBO has scored telemedicine legislation since 2001. In fact, the 2001 legislation erected the longstanding barriers for Medicare telehealth coverage now known as the 1834 (m) in the Social Security Act. It’s response about the decades-long halt to telehealth's place in the healthcare arena is summed up by Gary Capistrant, ATA Chief Policy Officer, "We support any home telehealth that can physically been done, and meet professional standards."
Audrey Kinsella, MA, MS, is HCTR's telemedicine reporter. She has written on home telehealthcare and new technologies for home care service delivery for 20 years, in 6 books, multiple web sites, and more than 150 published articles. Audrey can be reached at firstname.lastname@example.org or 828-348-5308.
©2017 by Rowan Consulting Associates, Inc., Colorado Springs, CO. All rights reserved. This article originally appeared in Tim Rowan's Home Care Technology Report. homecaretechreport.com One copy may be printed for personal use; further reproduction by permission only. email@example.com