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Making Telehealth a Valuable Part of Preventive Care Programs

A bill before Congress would give the Congressional Budget Office more leeway in scoring preventive care legislation. Supporters say it would open the door for more Medicare coverage of telehealth.

Source: ThinkStock

By Eric Wicklund

- An under-the-radar bill introduced in Congress last year could, if passed, pave the way for Medicare coverage of telehealth in preventive health programs.

The Preventive Health Savings Act (S. 2164 and H B.. 2953) proposes to expand the window by which the Congressional Budget Office scores legislation targeting disease prevention programs from 10 years to 30 years. This would enable the CBO to better analyze the long-term health and wellness effects of these programs, rather than focusing on immediate outcomes.

James S. Tam and Charles C. Dunham IV, attorneys with the Epstein Becker Green law practice, say this would make telehealth a more attractive component of Medicare programs.

“The U.S. incurs significant, but avoidable, costs related to the treatment of certain diseases and chronic care services, so preventive tools and services are beneficial as a means toward lowering such costs,” the two wrote in a recent blog on the National Law Review. “Telehealth services are well suited to be used as tools that connect patients to their health care providers in order to prevent diseases from occurring or to help maintain health conditions in order to prevent existing conditions from worsening. However, the savings to an individual’s health care costs that are associated with disease prevention would not be measured to their full effect in a shorter term window, as compared to the longer term (i.e., 30 year) window that these bills propose.”

“Telehealth services offer health care providers the opportunity and the capability to reach broader Medicare beneficiary populations and to serve as disease prevention tools for these populations,” they concluded. “Proponents of the bills believe that passage would allow the CBO to more accurately measure the financial savings associated with any legislation that is intended to broaden access by Medicare beneficiaries to telehealth services.”

READ MORE: Medicare Spending on Telehealth Increases, But Barriers Remain

Senator Angus King (I-Me.), the Senate bill’s chief sponsor (he also sponsored the bill in 2013 and 2016), says the proposed legislation would shift the emphasis in healthcare from overspending on short-term treatments to planning out preventive services that reduce the need for those treatments and promote long-term health.

“Regardless of who is writing the check, the current trajectory of healthcare spending is unsustainable,” he said in a November press release announcing the bill. “We need to make the most of options like preventive care, which is proven to control costs and improve the overall health of communities. By ensuring that future Congressional Budget Office studies extend beyond the existing ten-year budget window, this bill will help us fully understand the long-term benefits and maximize the impact of preventive care to improve overall health, in Maine and across the country.”

“The Preventive Health Savings Act recognizes the importance of preventing chronic diseases and promoting behavioral health,” added LaShawn McIver, MD, Senior Vice President of Government Affairs & Advocacy at the American Diabetes Association, one of 120 organizations supporting the bill. “We know that lifestyle support programs such as the National Diabetes Prevention Program lead to significant cost-savings that extend beyond the Congressional Budget Office’s traditional scoring window of 10 years. Evaluating cost-savings further into the future, as would be allowed by the Preventive Health Savings Act, will provide a more comprehensive appraisal of critical programs that promote wellness and disease prevention, while reducing health care costs and overall spending, and thus improving the lives of millions of Americans.”

The issue is a familiar one to telehealth and telemedicine advocates, who have long argued that the CBO is handcuffed in analyzing legislation because of guidelines that force the agency to analyze only short-term benefits.

That discrepancy was highlighted in a CBO analysis last August of the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 (S.870). The bill seeks to, among other things, eliminate restrictions placed by the Centers for Medicare and Medicaid Services (CMS) on telestroke use in non-rural settings, beginning in 2019, and allow healthcare providers to be reimbursed for services delivered by telemedicine to Medicare beneficiaries who’d had a stroke or were suspected of having one.

READ MORE: WorldClinic Founder: Telehealth Needs a New Revenue Model

The CBO found that the expansion of telestroke services in non-rural settings would cause increases in consultations, medications, treatment and post-acute care services, simply because more people would be treated via telehealth and the survival rate would increase. But the analysis couldn’t take into account long-term benefits and cost savings.

In 2015, Politico reported that the CBO has historically overestimated the cost of healthcare-related bills, by taking a conservative approach that doesn’t figure in long-term benefits.

That assertion wasn’t disputed by the agency.

“If all or most telemedicine services substituted for or prevented the use of more expensive services, coverage of telemedicine could reduce federal spending,” CBO officials noted in a July 2015 blog post. “If instead telemedicine services were mostly used in addition to currently covered services, coverage of telemedicine would tend to increase Medicare spending. Many proposals to expand coverage of telemedicine strive to facilitate enrollees’ access to healthcare. Therefore, such proposals could increase spending by adding payments for new services instead of substituting for existing services.”

”Because Medicare coverage of telemedicine is limited, CBO does not have extensive data that would help project how expanding such coverage would affect federal spending in the Medicare program,” the blog post concluded. “CBO’s analysis would benefit from having the results of new and well-designed academic studies examining how introducing telemedicine services would affect healthcare spending in the Medicare population. The results of a demonstration project conducted in the fee-for-service Medicare program could be especially valuable in light of the particular challenges of controlling spending on new benefits in that program.”

READ MORE: In Value-Based Care, Telehealth’s Aim is Money Saved, Not Earned

Supporters of the Preventive Health Savings Act now say the evidence is available for a more objective cost analysis of telehealth-friendly legislation – if the CBO is allowed to expand its scope.

“As proposed in the bill, the CBO would be required to score proposals based on reviewing publicly available scientific studies of preventive health and preventive health services, which the legislation broadly defines as ‘an action that focuses on the health of the public, individuals and defined populations in order to protect, promote, and maintain health and wellness and prevent disease, disability, and premature death,’” Tam and Dunham wrote. “The bill also would allow the CBO to review the budget savings for preventive health services extending into an additional two decades beyond the traditional 10 year budget window beyond legislation.”



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