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New Legislation Introduced to Expand Use of Telehealth Under Medicare

February 3, 2016
by Heather Landi
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Senator Brian Schatz (D-Hawaii) introduced bipartisan legislation Wednesday that would expand the use of telehealth and remote patient monitoring (RPM) services under Medicare with the goal of cost savings and quality care.

The bill has bipartisan support from Roger Wicker (R-Miss.), Thad Cochran (R-Miss.), Ben Cardin (D-Md.), John Thune (R-S.D.) and Mark Warner (D-Va.).

The bill, titled the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, would create a bridge program to help providers transition to the goals of the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) through using telehealth and RPM and would eliminate many of the current restrictions.

Currently, there are restrictions on reimbursement for telehealth and RPM services under Medicare, such as patients may only be located at certain clinical sites or within certain rural areas and only Medicare-defined physicians and practitioners can provide telehealth services but not physical or occupational therapists, for example.

A summary of the bill states that an analysis by Avalere, a consulting firm, estimated that provisions in the bill would result in $1.8 billion in savings over 10 years.  There is concern among telemedicine advocates about the Congressional Budget Offices’ review of the proposal and the cost estimate it will put on the proposed legislation. Congress put the current telemedicine restrictions in place in 2001. According to reports from the Center for Telehealth and eHealth Law, at that time, the CBO estimated telemedicine services would cost the Centers for Medicare & Medicaid Services (CMS) $150 million during the first five years, while CMS has reported that since 2001, Medicare reimbursement for telemedicine has totaled only $57.6 million during the past 14 years.

The bill would allow telehealth and RPM to be used by qualifying physicians in alternative payment models overseen by CMS without many of the current restrictions and permit the use of RPM services for certain patients with chronic conditions. And, the bill would expand the originating sites for the use of telehealth services to telestroke evaluation and management sites, Native American health service facilities and dialysis facilities for home dialysis patients in certain cases.

The legislation also would allow telehealth and RPM services to be basic benefits in Medicare Advantage without many of the current restrictions and would expand telehealth and RPM in community health centers and rural health clinics.

“Telehealth is the future of health care.  It saves money and improves health outcomes,” Sen. Schatz said in a statement.  “Our bipartisan bill puts us on a path to transform health care delivery, making it less costly and more convenient for patients and providers.”

The Connect for Health Act has garnered support from more than 50 healthcare industry organizations, including the American Medical Association, American Telemedicine Association, American Well, Anthem, the Association for Behavioral Health and Wellness, Kaiser Permanente and the Healthcare Information and Management Systems Society (HIMSS).

In a statement, the AMA said the bill reflects the AMA's belief that that the appropriate use of telemedicine can greatly improve access to quality care while maintaining patient safety.

“This legislation has the potential to remove barriers to new health care delivery models that promote coordinated and patient-centered care.  Importantly, the bill aims to maintain high standards whether a patient is seeing a physician in an office or via telemedicine," AMA president Steven Stack, M.D. said in an AMA statement. "Telemedicine can strengthen the patient-physician relationship and improve access for patients with chronic conditions and limited access to quality care. The AMA's guiding principles on telemedicine seek to foster innovation while promoting quality care."

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