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HIMSS Makes Its Pitch for Telehealth Legislation, Rural Broadband

HIMSS is lobbying Congress to support the CONNECT Act, which targets Medicare restrictions on telehealth and telemedicine, and invest in broadband expansion to rural parts of the country.

Source: ThinkStock

By Eric Wicklund

- One of the nation’s largest healthcare IT organizations is throwing its weight behind a telehealth bill stuck in Congress and investments in broadband infrastructure that would push telemedicine and mHealth into rural America.

The Healthcare Information and Management Systems Society (HIMSS) made those requests in its 2017 Congressional Asks, putting pressure on lawmakers to improve cybersecurity, adjust Medicare to allow more telehealth and boost funding for rural broadband expansion.

Specifically, HIMSS is asking Congress to pass the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, a bill originally introduced in 2016 that aims to remove roadblocks to telemedicine expansion in Medicare by giving 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.

“Telehealth services, and the technologies that support them, have the potential to expand access to high-quality care for patients in underserved communities (both urban and rural), address provider shortages, facilitate proactive disease prevention and chronic care management, and improve patient and provider satisfaction<’ the organization said in its letter to Congress. “However, current law prevents [the Centers from Medicare & Medicaid Services] from reimbursing most providers and health systems for telehealth services and remote patient monitoring (RPM).”

The CONNECT Act (H.R. 2556 and S. 1016) is one of several bills seeking to eliminate CMS restrictions on telehealth and telemedicine expansion – each of which has inched forward in first and starts. Congressional experts have expressed skepticism that any of the bills will be passed into law on their own, though there are hopes that a few could be added to other legislation deemed a higher priority by lawmakers.

READ MORE: Telehealth Supporters Lobby DC for Better Broadband Connectivity

When the bill was introduced in February 2016, an independent cost analysis by Avalere and Third Way estimated it would save the government at least $1.8 billion over 10 years, offsetting projected costs of $1.1 billion. Those numbers have prompted more than 50 organizations to support the bill.

“This legislation would advance patient-centered care through strategic and validated telemedicine and remote-patient monitoring tools and modalities,” AMA President Andrew W. Gurman, MD, said in a 2016 the press release. “Increasing Medicare coverage for these telemedicine services will help transform the next generation of health care delivery in ways that promote value and improved patient outcomes.”

Passage of the CONNECT Act, HIMSS said, would:

  1. Amend the allowable originating sites of care beyond those currently stipulated by CMS by removing geographic restrictions (i.e., currently not allowed in metropolitan statistical areas, and open only to rural Health Professional Shortage Areas) for patients in rural health clinics, federally qualified health centers, and Native American sites, among others.
  2. Eliminate the originating site and geographic restrictions on telehealth for Accountable Care Organizations, in global and bundled payments, and for Medicare Advantage enrollees.
  3. Allow expanded use of “store and forward capability” to aid long-term passive monitoring of chronic diseases (i.e., currently, only allowed in Alaska and Hawaii for federal demonstration projects).
  4. Expand coverage of remote patient monitoring for certain high-risk and high-cost patients (i.e., individuals receiving chronic care management or transitional care management services, or individuals who are in the top 5 percent of Medicare cost utilization and have two or more chronic diseases).
  5. Give the HHS Secretary direct authority to lift existing 1834(m) restrictions when certain quality and cost-effectiveness criteria are met.

HIMSS is also asking Congress to “invest in infrastructure to support 21st Century healthcare,” primarily by boosting funding for broadband expansion to rural and remote parts of the country where residents and healthcare providers lack a good Internet connection.

“Currently, many patients and providers in rural and underserved areas lack access to the affordable, quality broadband necessary to realize the full potential of health IT, including telehealth and remote patient monitoring, to support 21st-century healthcare,” the organization said. “There continues to be a significant disparity in access across America, with more than 39 percent of Americans living in rural areas lacking access to advanced telecommunications services, compared to just 4 percent of Americans living in urban areas.”

READ MORE: More Organizations Urge CMS to Boost Medicare Telehealth Coverage

“Research shows this lack of access is negatively affecting both patients’ health status and clinicians’ ability to provide the care needed to make their communities healthier,” HIMSS added. “Based on December 2015 data, the least connected counties (generally) have the highest rates of chronic disease. Obesity prevalence is 25 percent higher and diabetes prevalence is 41 percent higher in these counties (an increase of 6 percent over the prior year) where 60 percent of households lack broadband access.”

To improve those percentages, HIMSS is asking Congress to “modernize” the Federal Communications Commission’s Rural Health Care Program, which was established in 1997 with a $400 million cap and hasn’t been upgraded since. This year, demand for funding exceeded the cap for the first time.

Specifically, HIMSS is asking Congress to increase that $400 million cap “to a suitable level that accounts for the increase in demand and the advances in technology capabilities since 1997” and create a formula that adjusts the cap for inflation. If that’s not possible, it’s urging Congress to “explore alternative funding opportunities (e.g., public/private partnerships) that support broadband infrastructure deployment for rural healthcare providers.”

The issue has hampered healthcare services in at least two states. Earlier this year, legislators in Montana shot down proposed telemedicine standards, saying the state couldn’t set guidelines on broadband-based services if its residents couldn’t access them.

And in Alaska, legislators drafted a petition asking the FCC to boost its Rural Health Care Universal Service Support Fund so that the state could invest in broadband expansion.

READ MORE: What Telemedicine, Telehealth Resource Centers Offer to Providers

“The long-distance delivery of quality healthcare via telemedicine has made great strides in rural Alaska in recent years,” Rep. Bryce Edgmon (D-Dillingham), the resolution’s sponsor, said in a news release. “However, we’re about to hit a roadblock.  Increasing the FCC support budget will allow healthcare providers in isolated communities to continue expanding local treatment options in ways we never could have dreamed of just a few years ago.”

“Telehealth allows patients in rural parts of Alaska access to state-of-the-art diagnostic tools and treatments that can help the sick and afflicted,” added Rep. Zach Fansler (D-Bethel). “This resolution puts the House on record supporting a proactive solution to a looming problem potentially jeopardizing healthcare for hundreds of thousands.”

In addition, HIMSS is asking Congress to adopt the Centers for Disease Control and Prevention’s “Vision for Public Health Surveillance in the 21st Century.” The CDC document calls on public health agencies and healthcare providers to improve information sharing and data collection through electronic reporting, with appropriate federal funding in the infrastructure.

Finally, HIMSS is calling on Congress to elevate the Health and Human Services Department’s Chief Information Security Officer (CISO) to a position equal to that of the CIO, to meet the growing threat of cybersecurity breaches and hacking attempts in healthcare.

“Given the massive amounts of patient information stolen by hackers, cybersecurity is a top concern for the health sector,” HIMSS said. “The impact of a significant security incident to a healthcare organization is not just financial or reputational. Such an incident may have an adverse effect on patient safety (e.g., a hacked EHR system with tampered information, or a connected medical device under the control of a hacker which may deliver a fatal dose of medicine to a patient), or cripple patient care by making unavailable essential IT systems and data necessary to provide care.”

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