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Telehealth News

Telehealth a Part of CMS Proposed Next Generation ACO Model

By Ryan Mcaskill

The proposed Next Generation ACO model will increase the reimbursement rate of telehealth services for Medicare beneficiaries.

One of the biggest hurdles to the widespread adoption of telehealth services is less than desirable reimbursement rates. A number of states are debating legislation that would increase Medicaid payment rates and physicians are ready to implement plans when it makes financial sense to do so.

With the technology needed to successfully run a telemedicine solution maturing and finding its way into the hands of patients with smartphones and tablets, using it for healthcare is an inevitability. Stories about using video conferencing are starting to become more common. Last week, news outlets reported on a woman who gave birth in her doctor’s office, while her doctor used FaceTime to walk her staff through the birthing process.

Recently, the Centers for Medicare & Medicaid (CMS) announced a new Next Generation Accountable Care Organization (ACO) model. It focuses on new opportunities to set predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care and improve quality standards.

One of the ways this is proposed is by extending coverage for telehealth services to Medicare beneficiaries. It allows coverage without regard to longstanding rural and institution restrictions. It will also extend coverage to 80 percent of Medicare beneficiaries located in metropolitan areas.

Patrick Conway, MD, the Deputy Administrator for Innovation and Quality and Chief Medical Officer at CMS, expanded on the Next Generation ACO model in a blog post for the organization. He wrote that this system builds off previous models, including the Pioneer ACO Model and Medicare Shared Savings Program.

“The Next Generation ACO Model encourages greater coordination and closer care relationships between ACO providers/suppliers and beneficiaries by enhancing services that beneficiaries can receive from participating ACOs. ACOs will have a number of tools available to enhance the management of care for their beneficiaries,” Conway wrote. “These include additional coverage of telehealth and post-discharge home services, coverage of skilled nursing care without prior hospitalization, and reward payments to beneficiaries for receiving care from ACOs.”

Following the announcement, American Telemedicine Association CEO Jonathan Linkous released a statement applauding this move by CMS. The new model puts ACOs on the same reimbursement level as the Medicare Advantage plans.

“For nearly four years, ATA has urged CMS to waive all the Medicare restrictions for all ACOs,” said Jonathan Linkous, CEO of ATA. “This is an important change in CMS policy and attitude. We hope it will encourage CMS and Congress to further open up all value-based payment plans to telehealth.”

Telehealth technology has arrived and it will only be a matter of time before reimbursement rates are increased to meet the demand of healthcare professionals.

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