Burwell Asked to Lift Barriers on Telehealth Reimbursement

Ken Terry

June 11, 2014

In 3 separate letters, organizations representing a broad array of healthcare stakeholders asked the newly confirmed Secretary of Health and Human Services Sylvia Matthews Burwell to have her department reimburse accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) for telehealth and remote patient monitoring services. To do so, Burwell would have to waive current regulations that severely limit Medicare's coverage of telemedicine.

The organizations that authored the letters include the Alliance for Connected Care, the American Telemedicine Association (ATA), the Health Information and Management Systems Society (HIMSS), and the National Association of ACOs, which includes healthcare organizations such as Danville, Pennsylvania–based Geisinger Health; Phoenix, Arizona–based Banner Health; the Marshfield Clinic in Wisconsin; and the Ochsner Health System in New Orleans, Louisiana.

At this time, the letters note, Medicare covers only a limited set of services provided through certain types of telecommunications systems to beneficiaries in rural areas, who must travel to an "originating site" to use these services. The ATA/HIMSS letter said this regulation excludes the 80% of Medicare beneficiaries who live in nonrural areas. It also excludes coverage for services originating from a patient's home and telehealth/remote monitoring coverage for most procedure codes.

Citing projections that remote monitoring alone will result in global savings of $36 billion by 2018, with North America accounting for three quarters of those savings, the ATA/HIMSS letter said providing ACOs with the ability to use advanced telehealth and monitoring solutions is "consistent with the goals of the MSSP — namely, improved quality of care and reduced costs."

In addition, the letter argued, this approach would be consistent with the Affordable Care Act, which requires ACOs participating in the MSSP to "define processes...to coordinate care, such as through the use of telehealth, remote patient monitoring, and other such enabling technologies."

Let's Talk

In addition to waiving the current restrictions on Medicare reimbursement, the ATA/HIMSS letter and the letter from the Alliance for Connected Care asked Burwell to request public input on the issue in the upcoming Notice of Proposed Rulemaking on the MSSP.

The letter from the National Association of ACOs focused on how the telehealth restrictions "negatively impact our ability to provide and coordinate high quality care for our patients while reducing costs."

After describing how telehealth could help ACOs fulfill their mission, the association's letter noted that the department's current policy "creates a disincentive for the vast majority of ACO providers...to use this type of technology." ACOs working with providers who are not reimbursed for telehealth face the choice between providing this care for free, which is not an option for many physician-led and smaller ACOs, or not providing it at all, the letter said.

The Alliance for Connected Care's letter noted, "For ACOs, the existing statutory and regulatory framework hinders their ability to better manage care and treat their beneficiary population in less costly care settings. These barriers are also counter to the Medicare Shared Savings Program's goal of ACOs having the ability to coordinate care using telehealth, remote patient monitoring, and other such enabling technologies."

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