- A bill to boost telehealth coverage in Medicare Advantage plans would reduce healthcare expenditures by $80 million over the next decade, according to the Congressional Budget Office.
The CBO’s cost estimate of H.R. 3727 is welcome news for telehealth advocates looking to cut into Medicare’s coverage and reimbursement restrictions and make telehealth and telemedicine and more accepted standard of care. But at the same time, the fate of this and close to a dozen other telehealth-flavored bills rests on a deeply divided Congress that hasn’t had much success passing any legislation of note lately.
The CBO estimate came on the same day that the Senate unanimously passed a much larger telehealth bill, the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017.
S. 870, which aims to push Medicare costs down by improving chronic disease management services and care coordination at home, also received a positive CBO review. But experts say the bill has little chance of making it through the House.
Telehealth advocates, meanwhile, are hoping that smaller, more focused bills like H.R. 3727 might pass Congressional muster by being attached to more important bills, like those reauthorizing Medicare extender programs.
Introduced on Sept. 11 by US Reps. Diane Black (R-Tenn.), Mike Thompson (D-Calif.), Doris Matsui (D-Calif..) and Susan Brooks (R-Ind.), the Increasing Telehealth Access to Medicare Act would enable MA plans to reimburse for telehealth services at comparable rates to in-person services beginning in 2020.
It also calls for Medicare coverage in chronic care management plans, beginning in 2019, of “services furnished through the use of secure messaging, Internet, store and forward technologies or other non-face-to-face communication methods determined appropriate by the [Health and Human Services] Secretary.” And it calls for access parity for telehealth services between Medicare part A and B programs and those in Medicare Advantage.
The bill received unanimous approval by the House Committee on Ways and Means on Sept. 14 and has the support of, among others, the Health IT Now coalition.
“Medicare lags the majority of other health payers – including Medicaid, the private sector, the Department of Veterans Affairs, and the Federal Employees Health Benefits Program – in recognizing the promise of telehealth,” the coalition’s executive director, Joel White, wrote in a letter to the bill’s sponsors. “Previous Congressional attempts to expand telehealth under Medicare have fallen short due to concerns about overutilization of care under Medicare’s traditional fee-for-service structure. Under this structure, there are powerful incentives for providers to bill Medicare for as many services as possible. Under Medicare Advantage’s payment system, however, that incentive is flipped on its head.”
According to the CBO report, MA plans would increase direct spending by some $46 million through 2022 as those plans cover extra telehealth services, but cost savings would then kick in as those plans learn to manage those new services and consequently lower their bids.
In all, the CBO estimates the bill would culminate in a $4 million savings in direct costs, as the bill also increases amounts earmarked for the Medicare Improvement Fund during FY 2021 by $76 million.
The CBO report also notes that the telehealth savings contained in H.R. 3727 are the same as those estimated for the CHRONIC Care Act of 2017.