A bipartisan bill introduced to Congress this week might have an impressive list of supporters and some pretty heady projections on cost savings, but can it succeed where so many promising bills before it have failed?
Long-anticipated and heavily hyped, the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act targets a big roadblock in the healthcare ecosystem’s adoption of telehealth – Medicare, and its confusing and sometimes antiquated restrictions for telehealth access and reimbursement. If approved, it would give providers the freedom to experiment with telehealth in alternative payment models and incentive programs and expand remote patient monitoring programs for chronic care, remote and underserved populations.
Senate bill S.2484 sponsored by Sens. Brian Schatz (D- Hawaii), John Thune (R-S.D.), Mark Warner, (D-Va.), Roger Wicker (R-Miss.), Thad Cochran ((R-Miss.) and Ben Cardin (D-Md.), essentially gathers most of the strong points of previous bills and consolidates them into one targeted piece of legislation designed to remove the barriers that have kept health systems from adopting telehealth technology. A companion bill in the House is being co-sponsored by Reps. Gregg Harper (R-Miss.), Diane Black (R-Tenn.) and Peter Welch (D-Vt.).
“Telehealth is the future of healthcare. It saves money and improves health outcomes,” Schatz said in a press release. “Our bipartisan bill puts us on a path to transform healthcare delivery, making it less costly and more convenient for patients and providers.”
The bill comes with some ambitious cost projections. An independent cost analysis by Avalere and Third Way estimates it would save the government at least $1.8 billion, offsetting projected costs of $1.1 billion for the waiver program.
“If true, that’s a significant development,” says Eli Greenspan, Alexander Hecht and Rodney J. Witlock, attorneys with Mintz Levin Cohn Ferris Glovsky and Popeo PC, writing in Lexology. “For years, telemedicine advocates have heaped praise on the potential cost savings associated with telemedicine through increasing access to care, whether it be through video conferencing or remote patient monitoring services.”
They also sounded a warning note. The bill will have to be scored by the Congressional Budget Office, “which has consistently and steadfastly expressed skepticism that expanding the use of telemedicine would cut costs for Medicare, often citing the potential for increased utilization of services – and thereby increased costs to the taxpayer.”
At the same time, the three attorneys noted that the CBO has also questioned its own ability to properly score telehealth bills that would affect federal spending in Medicare, due to a lack of demonstration projects.
The bill drew strong support from a wide variety of organizations and telehealth companies.
“This legislation has the potential to remove barriers to new healthcare delivery models that promote coordinated and patient-centered care,” Steven J. Stack, MD, president of the American Medical Association, said in prepared remarks after the bill’s introduction. “Importantly, the bill aims to maintain high standards whether a patient is seeing a physician in an office or via telemedicine.”
“Telemedicine can strengthen the patient-physician relationship and improve access for patients with chronic conditions and limited access to quality care,” he added. “The AMA’s guiding principles on telemedicine seek to foster innovation while promoting quality care.”
Joining the AMA to support the bill are the American Telemedicine Association, American Nurses Association, the APP Association, the American Heart Association, the ERISA Industry Committee, the Alliance for Connected Care and the American Medical Group Association, among others.
“We are proud to support legislation that promotes healthcare delivery models in the interest of both the patient and the physician,” Jonathan Linkous, the American Telemedicine Association’s CEO, said in a statement. “Telehealth services widen the pool of healthcare options while enabling physicians to treat even more patients. This bill would bring us a step closer to the best healthcare quality and outcomes.”
“The ERISA Industry Committee chose to support the CONNECT for Health Act because we believe this bill will bring real change to telehealth, increasing access while reducing barriers for both patients and providers,” added Annette Guarisco Fildes, president and CEO for the ERISA Industry Committee (ERIC) in another press release. “ERIC welcomes Medicare’s increased support of telehealth, as it signals a recognition of the benefits and opportunities associated with telehealth, including cost savings and quality care.”
Also weighing in was Robert Jarrin, Qualcomm's senior director of government affairs, who called the bill a "well drafted, bipartisan, bicameral effort, that Qualcomm is happy to fully endorse."
"Technological modernization of healthcare delivery has begun, whether providers like it or not," he told Politico. Added the online news service: "The government is set to change its reimbursement models substantially, with the coming of MIPS and alternative payment models, Jarrin notes, but 'there's little bridging the transition ... from today's fee-for-service technologically impaired nightmare.'"
Specifically, the bill would create bridge programs that allow providers to use telehealth and RPM to meet the goals of Medicare Access and CHIP Reauthorization Act (MACRA), Merit-based Incentive Payment System (MIPS) and other alternative payment models by eliminating 42 U.S.C. 1834(m) restrictions. It would also enable Medicare Advantage to cite RPM and telehealth as basic benefits without 1834(m) restrictions, and clarify that telehealth and RPM technologies would not be considered “remuneration.”
The bill would also expand RPM and telehealth programs for certain chronic condition populations, as well as at community health centers and rural clinics, and qualify telestroke evaluation and management sites, Native American health service centers and dialysis facilities for certain home dialysis patients as originating sites.
“Technology has enormous potential to transform the Medicare program,” Sen. Mark Warner said in introducing the bill. “As Governor of Virginia, I saw up close how telehealth improved efficiency, access and outcomes in Medicaid. Moving forward, we should look for more ways to harness innovation and give Medicare providers more tools for delivering care. This bipartisan bill provides a strong starting point, building on the progress we’ve already made in Virginia, and includes strong quality metrics to give us a better sense of what works and what doesn’t as our healthcare system moves further into the 21st century.”