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GAO Report: Telehealth Troubles Tied to Reimbursement Barriers

The GAO report finds that telehealth and remote patient monitoring services aren't being used much by Medicare, Medicaid, VA or DOD beneficiaries, mainly due to reimbursement and coverage issues.

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- Healthcare providers aren’t embracing telehealth and remote patient monitoring because they aren’t being reimbursed for those services, according to a new report from the U.S. Government Accountability Office.

The GAO report, issued last week as part of the Medicare Access and CHIP Reauthorization Act of 2015, found that Medicare, Medicaid, the Veterans Administration and the U.S. Department of Defense used telehealth to treat 12 percent or less of their beneficiaries in 2014 through 2016, with less than 1 percent of Medicare beneficiaries using any telehealth services.

Providers surveyed for the report cited “the potential to improve or maintain quality of care as a significant factor encouraging the use of telehealth and remote patient monitoring,” but they rated “cost increases or inadequate payment and coverage restrictions” as either somewhat or very significant barriers to adoption.

“Additionally, officials from another provider association described coverage as the single greatest barrier to the use of telehealth, adding that Medicare’s restrictions on the types of services covered by the program have prohibited its broader use,” the report found. “Regarding remote patient monitoring, officials from another provider association stated that Medicare’s valuation methodology for services results in low payment rates for remote patient monitoring, which these officials said remains a principal barrier to the use of these services.”

One of the bigger challenges in Medicare reimbursement, the study found, lay in the “originating site” requirement: Medicare will only reimburse for telehealth services delivered from a certified healthcare provider in a rural area, and not a home or urban area. According to a 2016 report by the Medicare Payment Advisory Commission (MedPAC). 55 percent of the 175,000 Medicare telehealth claims paid in calendar year 2014 did not specify an originating site.

While the absence of an originating site claim doesn’t automatically mean the reimbursements are improper, the MedPAC report did find that 44 percent of those telehealth claims in 2014 “were associated with beneficiaries living in urban areas,” and one providers was found to have conducted 2,000 telehealth visits in a single year, all from an urban area. The Centers for Medicare & Medicaid Services (CMS) is reportedly reviewing the MedPAC report

Another barrier cited by providers was infrastructure requirements, especially “access to sufficiently reliable broadband internet service.” Also cited, but by far less providers, were training, cultural barriers and professional licensure issues.

To overcome those barriers and spur telehealth and RPM adoption, the GAO report noted that CMS has several programs underway that support innovate payment and service delivery models to reduce Medicare, Medicaid and state Children’s Health Insurance Program (CHIP) expenses, including next-generation Accountable Care Organizations, Bundled Payments for Care Improvement models and Episode Payment Models.

The report also took note of the new Merit-based Incentive Payment System included in this year’s CMS Quality Payment Program.

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