- Telehealth should be an integrated standard of care for people with chronic conditions, not a separate path of care alongside traditional in-person visits.
That’s the early take from comments so far submitted to the Senate Finance Committee by healthcare organizations and advocacy groups, including the American Hospital Association, the American College of Physicians and National Coalition on Health Care. The consensus is that current rules and standards should be revised to more broadly accept and support telehealth, rather than creating new guidelines for care.
That would also include moving beyond telehealth policies that match what’s reimbursed under fee-for-service programs and looking at new models of care coordination payment.
“Comprehensive changes to the telehealth statute – such as eliminating the geographic location and practice setting ‘originating site’ requirements and removing restrictions on covered services and technologies (including store-and-forward technology and remote patient monitoring) – are needed to realize fully the promise of telehealth for Medicare beneficiaries,” The AHA wrote in its letter to the Senate Finance Committee and its Chronic Care Working Group (CCWG), in which it noted that more than half of the nation’s hospital are now using telehealth technology.
The AHA also called for more research on the benefits of telehealth compared to its cost. “Although evidence on the quality and access benefits of telehealth continues to grow, there are insufficient studies on the cost-benefits of telehealth outside of certain services, such as telestroke,” its letter stated. “More and better research is needed for other conditions and newer technologies, such as remote monitoring of patients.”
More than once in its letter, the AHA urged lawmakers to seek consistency in telehealth by revising current policies, rather than creating new ones, and allowing more reimbursement for a broader range of telehealth services.
The ACP, in a 27-page letter to lawmakers, called for modifications to ACO guidelines to allow all ACOs – not just those using two-sided risk models – to expand their use of telehealth, primarily by removing geographical restrictions. It also asks that originating site restrictions be lifted on stroke programs to enable them to use telehealth more freely.
The AHA also called for more ACO flexibility.
“Telehealth is an important tool to assist all ACOs, regardless of risk track, with providing quality, coordinated care to Medicare beneficiaries,” the organization wrote. “We acknowledge the CCWG’s concern about curbing the potential overutilization of telehealth services. However, Track 1 ACOs that have not accepted downside risk have an important incentive to prevent unnecessary utilization, in that they still are measured against a financial benchmark, and excess utilization that leads to increased spending would cut into any potential savings such ACOs could realize. Further, for these same reasons, we urge the CCWG to explore including telehealth waivers in all new Medicare payment and delivery models.”
In addition, the ACP urged lawmakers to legislate that the Centers for Medicare & Medicaid Services create new chronic care management codes for reimbursement. Among them would be codes that reimburse for e-consults involving hospitals, primary care providers and specialists.
In its letter to lawmakers, the National Coalition on Health Care asked for more flexibility in Medicare Advantage plans and ACOs to use telehealth.
“(T)elehealth should not be considered just another supplemental benefit; it ought to be considered a means of delivering a broad range of Medicare benefits,” the NCHC wrote. It also argued for the lifting of geographic restrictions on telehealth use for both ACOs and stroke services.
Alongside these missives to the Senate Finance Coommittee, the Health Information and Management Systems Society (HIMSS) and the Personal Connected Health Alliance (PCHA) sent their own comments this month to the Agency for Healthcare Research and Quality. The AHRQ had issued a Technical Brief in December 2015 that called for more evidence of “the value of telehealth and remote patient monitoring, particularly for the chronically ill, 2 with a focus on expanding access to care and reducing costs.”
In its three-page letter, HIMSS and the PCHA called on the AHRQ to expand its telehealth standards to support remote patient monitoring and continuity of care as it applied to population health. The two organizations also asked that patient engagement be included in outcomes.
The two organizations also asked the AHRQ to “broaden its evaluation to include telehealth encounters that go beyond isolated interventions constrained to direct encounters with patients.”
“As noted in the technical brief, the size and scope of healthcare delivery in a virtual sense has expanded dramatically over recent years,” the letter said. “In addition, many of these studies leverage telehealth and remote patient monitoring as ancillary to other supportive technologies to achieve outcomes, cost savings, and to better engage patients.”