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Payers urge CBO to Give Telemedicine a Fair Shake

Almost a dozen of the nation's largest health plans say telemedicine and telehealth should play a more important role in the Congressional Budget Office's review of Medicare bills.

By Eric Wicklund

- Nearly a dozen national health plans have asked the Congressional Budget Office to pay more attention to telemedicine when scoring Congressional bills on Medicare.

In a letter to CBO Director Keith Hall, 11 health plans say telemedicine programs serve “as an important tool in increasing consumer access to high quality, affordable healthcare, improving patient satisfaction and reducing costs.” Yet federal legislation has thrown up roadblocks to the expansion of telemedicine platforms, especially in Medicare Advantage programs.

“While many of us are embracing telemedicine in our offerings outside of Medicare Advantage (MA), we want to clearly note that the barriers in Medicare hamper our ability to offer these services to our MA customers,” the letter states. “We have worked closely with [the Centers for Medicare & Medicaid Services] to find ways to provide telemedicine through MA plans, but can only do so as a supplemental benefit.”

“Our options are also limited without Congressional action to reduce barriers in the Medicare fee-for-service benefit,” the letter continues. “Congressional action depends, in part, on a budget impact analysis from your office.”

This isn’t the first time the CBO has been asked to pay attention to telehealth. Late last year Politico reported on critics who said the budget office has historically overestimated the cost of healthcare-related bills, thus reducing their chances of success. CBO officials even acknowledged that issue in a July 2015 blog.

“If all or most telemedicine services substituted for or prevented the use of more expensive services, coverage of telemedicine could reduce federal spending,” the blog noted. “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.”

In its defense, the CBO argued that not enough studies have been done to prove telemedicine’s value.

The health plans issuing this latest letter to the CBO disagree.

The letter - signed by Aetna, Anthem, Blue Cross Blue Shield of Tennessee, Cambia Health Solutions, CareSource, EmblemHealth, HMSA-Blue Cross Blue Shield of Hawaii, Horizon Blue Cross Blue Shield of New Jersey, Humana, Molina Healthcare and MVP Health Care – notes that telemedicine is making its presence felt in several other federal programs. This includes new payment models put forth by CMS and MACRA, as well as state Medicaid programs and the Veterans Health Administration.

“We encourage the Congressional Budget Office to look to data available in our commercial programs and other public programs to assist in informing utilization and cost estimates when evaluating potential cost impacts of removing barriers to utilizing telemedicine in Medicare,” the letter concludes. “We believe that in its role as a payer, Medicare, too, could see similar outcomes and improved access and care for millions of our nation’s seniors and people with disabilities.”

The health plans’ letter follows a similar tack taken by dozens of health systems and telemedicine advocates this past May. That letter urged the CBO and the Medicare Payment Advisory Commission to “look to evidence of telemedicine’s effectiveness from the commercial sector, the Department of Veterans Affairs (VA), Medicaid, and other programs when producing future cost estimates and analyses of telemedicine utilization in the Medicare program.”

“We recognize the difficulty of finding sufficient Medicare data on telemedicine given that it is virtually unused in the Medicare program,” that letter stated. “However, alternative data sources can and should be used to inform and produce an analysis of providing Medicare beneficiaries access to telemedicine, including telehealth and remote patient monitoring.”

Dig Deeper:

AAFP Criticizes CMS on Telemedicine Reimbursement Restrictions

Making Telehealth a Priority: Congress Mulls Changes to Medicare


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