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CMS Urged to Reimburse Telehealth for Stroke, Cardiac Care

The American Heart Association's new policy statement calls on Medicare to support and reimburse providers using telehealth to treat stroke and cardiovascular cases.

By Eric Wicklund

- The American Heart Association is calling on Medicare to support telehealth, saying the technology is “tragically underutilized” to treat stroke patients and those with heart disease and could save the country billions of dollars and thousands of lives.

The AHA’s 22-page policy statement, published in the organization’s online journal Circulation, comes on the heels of passage of the 20th Century Cures Act, which – among other things – calls on the Center for Medicare & Medicaid Services (CMS) to study how Medicare can better support telehealth services for those with chronic conditions.

AHA officials say telehealth has proven its value in treating stroke patients and those with heart issues, but is severely hampered by legal and regulatory restraints, including licensure limits, and a lack of reimbursement from both federal and private payers.

Among the agencies singled out for criticism in the report is the Congressional Budget Office, which “continues with very conservative estimates on the cost savings of telehealth and therefore projects cost estimates so large as to prohibit successful legislative passage.”

“With heart disease and stroke being leading causes of death in our nation, our healthcare system must continue to adapt to take full advantage of proven forms of treatment, like telehealth, that can effectively fight these deadly diseases and advance health care quality,” AHA CEO Nancy Brown said in a press release accompanying the report. “Barriers must be removed so that more Americans suffering from CVD and stroke, regardless of where they live, can reap the benefits of this valuable type of care.”

READ MORE: Bill Seeks Medicare Reimbursement for New Telehealth Programs

The AHA is calling for Medicare to provide coverage for “all evidence-based telehealth services for cardiovascular and stroke care,” and asks for coverage and payment parity across all states. It also recommends that CMS:

  • Ensure that all properly trained providers are deemed eligible providers for telehealth interventions, without restricted networks that would limit reimbursement by provider;
  • Encourage the development of simpler, less expensive technology platforms that allow for inter-operability between systems and keep the patient burden and costs for health care systems as low as possible;
  • Ensure that large electronic health record systems incorporate telehealth and make it compatible with traditional health records to promote a single integrated health record for all patients;
  • Encourage the development of improved education for providers to simplify the process of delivering telehealth and increase adoption among providers;
  • Ensure that adoption of telehealth does not sacrifice quality in the name of cost-savings, such as by restricting patient access to limited networks of telehealth specialists rather than in-person specialty care, and promotes high quality care delivery;
  • Invest in additional research to determine the cost-effectiveness of new telehealth interventions.

According to the AHA, stroke and cardiovascular disease account for $353 billion in healthcare costs annually, with that price tag expected to soar to nearly $1 trillion by 2030. Yet Medicare used only $17.6 million of its $646 million in expenditures during the past year to cover telehealth services in those areas.

Telehealth is not only a proven tool for increasing access to high quality cardiovascular and stroke care for many patients, but it also meets all of the National Academy of Medicine’s domains of quality. It is recognized as safe, timely, effective, equitable, efficient and patient-centered care,” Lee Schwamm, MD, lead author of the policy statement, said in the press release.  “With increasing physician shortages, rising costs and a burgeoning demand for treatment, telehealth can greatly improve value in health care and, most importantly, produce better health outcomes for all.”

The AHA’s statement builds on a 2009 policy statement that called on the nation to build up its telemedicine resources for stroke care. It follows a scientific statement released just last month, in conjunction with the American Stroke Association, on quality measures and outcomes for the use of telemedicine in stroke cases – a document which included the first-ever proposed set of standards for telestroke services.

"Telestroke has evolved over the last decade and is now used quite extensively to take care of acute stroke patients in the U.S. and the rest of the world," Lawrence R. Wechsler, MD, chairman of the AHA/ASA writing committee, told Medscape. "Because of this we felt it was time to bring out this statement, which provides a structure against which hospitals can measure the quality of their telestroke programs so patients can be assured of getting the quality they deserve."

READ MORE: WEDI Brief Outlines Challenges to Telehealth Reimbursement

The AHA has also sought to give mobile health tools their due in the treatment of heart disease and strokes. In 2015, the organization issued a scientific statement supporting mHealth interventions – including apps, fitness trackers and remote monitoring tools – in preventing and treating cardiac disease.

“Numerous innovations in health information technology are empowering individuals to assume a more active role in monitoring and managing their chronic conditions and therapeutic regimens, as well as their health and wellness,” that report noted. “These advances are increasingly accepted by the public. Unlike the initial digital divide that placed computer use and Internet access beyond the reach of many older, disabled, and low-income individuals, mobile devices have been widely adopted across demographic and ethnic groups, especially those most in need of health behavior interventions.”

“Mobile devices offer great promise for improving the health of the populace,” the report continued. “A systematic review of the literature suggests a positive impact of consumer health informatics tools on select health conditions.”

This past February, the AHA joined with IBM’s Watson Health and Welltok to launch two mHealth-based workplace programs to measure an employee’s cardiac health and a workplace’s cardiac health environment. And earlier this month, the AHA joined the Health Information and Management Systems Society (HIMSS), the American Medical Association and DHX Group to launch Xcertia, a partnership to “advance the body of knowledge around clinical content, usability, privacy and security, interoperability and evidence of efficacy” for mHealth apps.

With all that evidence at hand, the AHA says, now is the time to support and pay healthcare providers for using the technology.

READ MORE: Payers urge CBO to Give Telemedicine a Fair Shake

“If telehealth is to achieve its full potential, it should be integrated into the traditional ambulatory and hospital-based delivery models and leveraged to foster deeper patient engagement and patient-centered care,” the document states. “To do so will require re-evaluating the traditional healthcare encounter with a clear understanding of patients’ and providers’ expectations and the implementation of evidence-based telehealth interventions.”

Dig Deeper:

Telehealth Reimbursement and Its Interstate Licensure Problem

Understanding the Value-Based Reimbursement Model Landscape

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