Legislation that would expand the use of telehealth services for Medicare stroke patients located in non-rural areas would cost the federal government $180 million over 10 years, according to the Congressional Budget Office (CBO).
CBO, a nonpartisan federal agency that provides budget and economic information to Congress, released its cost estimate report last week on H.R. 1148, the Furthering Access to Stroke Telemedicine Act of 2017.
Introduced by Rep. Griffith (R-VA) and Rep. Beatty(D-OH), the Furthering Access to Stroke Telemedicine (FAST) Act, if passed, would increase timely access to trained neurologists through telemedicine in the Medicare program so neurologists can direct patient care at the earliest possible intervention point, the bill authors state.
Currently, Medicare will only pay for such a consultation if the originating site hospital is in a rural Health Professional Shortage Area or a county outside a Metropolitan Statistical Area, according to the bill sponsors. “However, 94 percent of stroke patients live in urban and suburban areas. Stroke is currently the 5th leading cause of death and is projected to increase significantly; associated costs are projected to triple by 2030. However, with quick treatment, stroke patients can mitigate subsequent medical complications and disability, but every minute can count,” the bill sponsors wrote in a memo.
The CBO report states that, under current law, coverage of telehealth services is restricted to Medicare beneficiaries in rural areas. Beginning on January 1, 2021, H.R. 1148 would remove that geographic restriction for telestroke services (a subset of telehealth services that involves consultation with a neurologist for a patient suspected of having had a stroke).
After its review, CBO concluded that spending—by the federal government and nonfederal providers combined—for a cohort would increase in the year in which the telestroke consultation occurs and then decline in subsequent years.
CBO stated that higher spending in the first year would be the result of additional consultations, more medications, additional treatment, and more spending for post–acute-care services during the 90 days after a hospital stay. Annual spending would be lower in subsequent years largely because the number of patients who are discharged from the hospital with moderate or severe disability would decline significantly as would spending for long-term care.
“Because Medicare does not cover long-term care services such as nursing home care, much of the savings from avoided long-term-care services would accrue to beneficiaries, other private payers, and state Medicaid programs—and not to the federal government. The federal government would share in the savings that accrue to state Medicaid programs,”