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American Hospital Association to House Committee: Make Telehealth Global

January 29, 2015
by Gabriel Perna
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Earlier this week, representatives from the Chicago-based American Hospital Association (AHA) sent a letter to the Committee on Energy and Commerce seeking a reform of Medicare policy on telehealth reimbursement.

The AHA’s letter is in response to the proposal from the Committee’s Advancing Telehealth Opportunities in Medicare initiative. The original proposal, released in mid-January, looks to expand the number of telehealth services covered by reimbursement and limit geographic restrictions. However, in a letter to Fred Upton (R-MI), Chair of the Committee on Energy and Commerce, the AHA’s executive vice president Rick Pollack says that would only happen if a Centers for Medicare & Medicaid Services (CMS) actuary certifies that adding those services would not add expenses to the program.

“Medicare already deploys a service-by-service consideration for telehealth that results in a “positive list” of covered services. It has proven to be a cumbersome approach that results in limited coverage. Given the rate of change in technology, and particularly in the use of technology in health care, a more nimble approach would be preferred,” Pollack writes.

He also says that removing geographic and other restrictions only for certain services creates real operational challenges and believes it could be very confusing for Medicare beneficiaries. “Why would they be able to benefit from the convenience of telehealth for one service, but not another?” Pollack asks.

AHA also wrote about its disappointment in several missing provisions from the Committee’s proposal.  Specifically, it says the proposal does not address the technology limitations of the current Medicare program nor does it address payment for remote monitoring. On the latter, AHA says it’s increasingly common and is demonstrated to provide significant benefits for patients.

There were some elements of the proposal AHA liked. Specifically, there was a part of the proposal encouraging the provision of telehealth services in demonstration projects and models under the Center for Medicare and Medicaid Innovation (CMMI) by waiving the current limitations on what qualifies to be an originating site and the geographic location of such sites.

“In conclusion, the AHA strongly agrees with your goal of expanding coverage of telehealth services in Medicare, and appreciates the specification of a mechanism for doing so. However, given the growing body of evidence that telehealth increases quality, improves patient satisfaction and reduces costs, we believe a more global approach to expanding Medicare coverage of telehealth is warranted,” Pollack writes.

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