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Is CMS Giving Telehealth Its Due In Its New Rural Health Strategy?

CMS has unveiled its first-ever Rural Health Strategy in an effort to improve access to healthcare for the estimated 60 million Americans living in rural areas. The plan includes an emphasis on modernizing and advancing telehealth and telemedicine.

Source: ThinkStock

By Eric Wicklund

- CMS is making telehealth and telemedicine a cornerstone in its first Rural Health Strategy.

The Centers for Medicare & Medicaid Services unveiled the first-ever program this past week, releasing a five-point, eight-page initiative to improve access to care for the estimated 60 million Americans living in rural and underserved communities.

“For the first time, CMS is organizing and focusing our efforts to apply a rural lens to the vision and work of the agency,” CMS Administrator Seema Verma said in a press release. “The Rural Health Strategy supports CMS’s goal of putting patients first. Through its implementation and our continued stakeholder engagement, this strategy will enhance the positive impacts CMS policies have on beneficiaries who live in rural areas.”

One part of the strategy focuses on using connected care technologies to bring healthcare to those residents.

“Telehealth has been identified as a promising solution to meet some of the needs of rural and underserved areas that lack sufficient health care services, including specialty care, and has been shown to improve access to needed care, increase the quality of care, and reduce costs by reducing readmissions and unnecessary emergency-department visits,” the plan states. “To promote the use of telehealth, CMS will seek to reduce some of the barriers to telehealth use that stakeholders identified in the listening sessions, such as reimbursement, cross-state licensure issues, and the administrative and financial burden to implement telemedicine.”

READ MORE: Telemedicine, Remote Care May Forestall Rural Hospital Closure

In its strategy, CMS says it will look to modernize and expand telehealth and telemedicine programs, particularly through the Next Generation Accountable Care Organization Model, Frontier Community Health Integration Project Demonstration and Bundled Payments for Care Initiative advanced model.

CMS has long come under criticism for its guidelines on reimbursing healthcare providers for telehealth delivered in rural areas, including restrictions on what services can be reimbursed under Medicare, where those services can be delivered, and even how rural areas are defined.

The agency has been the focus of several lobbying efforts to improve telehealth and telemedicine reimbursement, as well as several bills introduced in Congress. But few of those bills have become law, and healthcare providers still see Medicare reimbursement as one of the biggest barriers to pushing sustainable virtual care into rural America.

Last year, The Healthcare Information and Management Systems Society (HIMSS), American Medical Association (AMA), American Medical Informatics Association (AMIA), Center for Connected Health Policy (CCHP) and Personal Connected Health Alliance (PCHA) all called on CMS to go beyond current proposals to amend the Medicare 2018 physician fee schedule and open the doors to more connected care services.

“HIMSS encourages CMS to embrace a reimbursement system that recognizes the unique characteristics of connected health that enhances the care experience for the patient, providers and caregivers,” former HIMSS President and CEO H. Stephen Lieber and Denise W. Hines, chair of the HIMSS North America Board of Directors and CEO of the eHealth Services Group, wrote.

READ MORE: AHA Letter: Broadband Funding Cuts Threaten Telehealth Expansion

In that letter, HIMSS called on CMS to support:

  • Collaborative decision-making involving diverse care-teams. “Decisions are no longer just between a doctor and patient,” the organization wrote. “Connected technologies allow for the incorporation of a patient’s family and trusted advisors, as well as other allied health professionals, in the decision-making process.”
  • Expanded care locations and always-on monitoring. “When patients are always connected, care (the interpretation of data and decision support) can occur at any time and in any place,” HIMSS said.
  • A reliance on technology, connectivity and devices. “Connected health involves communication systems using a variety of components; these may be managed by the provider, the patient, or other parties in the care team,” HIMSS said.
  • And “empowerment tools and trackers that enable patients to become active members of the care continuum outside of the hospital setting and promote long-term engagement which, in turn, leads to a healthier population.”

Recognizing the challenges faced by healthcare providers in sustaining and scaling telehealth, the National Quality Forum (NQF) issued its own report last year, in which it proposed to set a national framework for measuring and supporting success in telehealth and telemedicine.

“Telehealth is a vital resource, especially for people in rural areas seeking help from specialists, such as mental health providers,” Marcia Ward, PhD, director of the Rural Telehealth Research Center at the University of Iowa and co-chair of NQF’s Telehealth Committee, said in a release accompanying the 81-page report. “Telehealth is healthcare. It is critically important that we measure the quality of telehealth and identify areas for improvement just as we do for in-person care.”

CMS’ Rural Health Strategy, developed by the CMS Rural Health Council, formed in 2016, and culled from input gained at 14 public hearings, features five objectives:

  1. Apply a rural lens to CMS programs and policies;
  2. Improve access to care through provider engagement and support;
  3. Advance telehealth and telemedicine;
  4. Empower patients in rural communities to make decisions about their healthcare; and
  5. Leverage partnerships to achieve the goals of the strategy.

The effort was met with words of support from several organizations.

READ MORE: Telehealth Barriers Should Be Defined by Access, Not Geography

“(The) AHA is pleased CMS put forward thoughtful recommendations to address the unique challenges of providing care to patients in rural communities,” Joanna Hiatt Kim, the American Hospital Association’s vice president of payment and policy, said in a release. “We look forward to working with CMS and Congress to take meaningful action to stabilize access in rural communities, such as creating new alternative payment models, expanding coverage of telemedicine and access to broadband and reducing regulatory burden.” 

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