MedPAC to Address Telehealth in Report to Congress

Regulation | September 13, 2017 | by Aaron Tripp

A component of the 21st Century Cures Act is a requirement for the Medicare Payment Advisory Commission (MedPAC) to report to Congress on the current and potential uses of telehealth in the Medicare program and to assist Congress in its ongoing assessment of Medicare coverage of telehealth services. A session at the September meeting described the beginning of MedPAC’s work on the report.

The next three MedPAC public meetings will have sessions building on the topics for the report due in March 2018. September’s session covered telehealth services for which payment can be made under Medicare Parts A and B in the fee-for-service program. October will focus on telehealth services with payment by private health insurance plans. November will examine the ways in which telehealth services covered under private insurance plans might be incorporated into the Medicare fee-for-service program. In January the commission will review the draft report.

Focusing predominately in telehealth through the physician fee schedule, MedPAC described low utilization in 2016. However, it was noted that Medicare has constraints on the use of telehealth through the physician fee schedule while other components in both fee-for-service, Medicare Advantage, and ACOs have greater flexibility. Some commissioner comments identified an interest in exploring targeting telehealth services and reimbursement to subpopulations based on specific diagnostic groups where incentives might promote high-value utilization. Other comments indicated research findings with evidence indicating that if LTPAC providers could participate in shared savings programs that might create incentives for further adoption of telehealth services.

LeadingAge Center for Aging Services Technologies (CAST) has a comprehensive portfolio of hands-on resources specific to telehealth and remote patient monitoring available for members that delivers valuable information leading to an understanding of telehealth and remote patient monitoring technologies, as well as these technologies’ uses and benefits. Technology-enabled services and supports are essential tools for long-term and post-acute care (LTPAC) providers to participate in the reform of the nation’s health
care system. Electronic health records, telehealth, telemedicine and other technologies can help LTPAC providers deliver integrated and person-centered care and services that support the health and wellness of older adults across the continuum. We believe them to be essential to strategic partnerships with physicians, hospitals and Accountable Care Organizations (ACO) as well as other coordinated care delivery models that will improve the quality of care and quality of life, while easing the burdens and cost of care.

As outlined in our aging services technology issue brief, LeadingAge urges Congress to include LTPAC settings in national health information technology (IT) initiatives, including the development, adoption and use of interoperability standards, the certification of IT products, and the engagement of LTPAC providers in incentive programs, as well as the Office of National Coordinator for Health Information Technology’s (ONC) technical assistance programs, and health information exchange activities. Such investments can reduce unnecessary hospitalizations, hospital readmissions, and can improve the quality of care in shared care as well as transitions of care.

The current limitations on the definition of telehealth, eligible originating sites, geography, eligible clinicians, etc. in the Social Security Act are significantly hampering the delivery of much needed efficacious services to older adults in different care settings and preventing providers participating in innovative care delivery systems from demonstrating the cost-effectiveness of these services. LeadingAge supports creation of a “bridge” program waiving the Medicare requirement that telehealth services occur at a qualified site, and requires providers to report annually on how telehealth technologies could reduce Medicare spending under the Merit-Based Incentive Payment System (MIPS). We recommend ensuring that LTPAC providers can participate in these demonstrations. Additionally, we support efforts that allow the Center for Medicare and Medicaid Innovation to test covering expanded telehealth services, certified enhanced telehealth service, and no limitations on geographic areas or location of the patient.