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Telehealth Bills Targeting Stroke Care, MA Plans Show Progress

Bills seeking to expand telehealth and telemedicine services for stroke victims and those on Medicare Advantage plans saw positive Congressional action, though they're far away from becoming law.

Source: ThinkStock

By Eric Wicklund

- Two bills designed to improve telehealth and telemedicine access sailed through Congressional subcommittee reviews on Wednesday.

The House Energy and Commerce Subcommittee on Health approved H.R. 1148, the Furthering Access to Stroke Telemedicine (FAST) Act, sending it on to the full committee for review. Meanwhile, the House Committee on Ways and Means unanimously approved H.R. 3727, the Increasing Telehealth Access in Medicare Act, which seeks to integrate telehealth into Medicare Advantage plans by 2020.

The FAST Act, introduced in February by U.S. Reps. Morgan Griffith (R-Va.) and Joyce Beatty (D-Ohio), would allow hospitals and mobile stroke units to qualify as an eligible site for “telehealth-eligible stroke services” under Medicare.

A companion bill in the Senate, S. 431, introduced in January by Senator John Thune (R-S.D.), would allow any site exclusively administering acute care stroke treatment to be included in the list of eligible Medicare sites, regardless of geographic location. That bill currently sits before the Senate Finance Committee.

“This critical bill would make a world of difference for stroke survivors facing barriers to telestroke services,” former American Heart Association President Steven Houser, PhD, said in a February press release announcing the House version of the bill. “Evidence indicates that telestroke improves patient outcomes and reduces disability. However, nearly 94 percent of the strokes that occur in America take place in areas where telestroke is not paid for by Medicare. We urge Congress to give more Medicare patients access to this proven form of treatment and support the FAST Act.”

READ MORE: The Benefits and Challenges of Telehealth for Specialists

The American Heart Association hailed Wednesday’s House action as a step forward in bringing urgent telemedicine services to stroke victims.

“Today’s House action on the association’s FAST Act legislation could not be more perfectly timed,” association President John J. Warner, MD, said. “Given the news this week that the stroke death rate has stalled, providing the very best care for Americans who suffer from strokes must be a top priority. This bill, which the association has championed for many years, will advance access to timely, high quality stroke care by expanding Medicare telemedicine reimbursement for 94 percent of stroke patients regardless of where they live.

“Last year, the Medicare Payment Advisory Commission, in its report to Congress, found telestroke to be one of the most beneficial and cost-effective applications of telehealth, and suggested lawmakers consider expanding Medicare coverage to urban locations,” he added. “The FAST Act accomplishes this goal, and we urge Congress to move this legislation forward and help us stop the tremendous toll stroke takes on families and our nation.”

An analysis of both versions of the FAST Act by the Center for Connected Health Policy found that the bill, if it becomes law, would still need some tweaking.

“For both bills, any site not already eligible as an originating site under current law would not be able to collect the facility fee, though those that continue to meet the requirements in current law would presumably still be eligible to receive an originating site facility fee,” the CCHP wrote. “Therefore, one hospital may be eligible to receive a facility fee while another may not. These varying qualifi­cations on sites could cause some confusion.”

READ MORE: Congress is Coming at CMS From All Angles With Telehealth Bills

“Additionally, these bills do not mandate the addition of any speci­fic CPT Code to the current list of telehealth reimbursable codes, and the most common codes used to bill for acute stroke care (99291 & 99292) are currently not reimbursable telehealth codes,” the analysis continued. “It is unclear if one of the existing telehealth eligible codes could be billed or if additional codes would need to be added through CMS’ standard review process in order to provide the acute stroke services addressed in these bills.”

The Increasing Telehealth Access in Medicare Act, introduced just this week by US Reps. Diane Black (R-Tenn.), Mike Thompson (D-Calif.), Doris Matsui (D-Calif.) and Susan Brooks (R-Ind.), reportedly sailed through its hearing with support from both sides of the aisle.

Among its fans is the Health IT Now coalition, whose executive director, Joel White, said the bill would “allow a significant portion of Medicare beneficiaries access to services via telehealth.”

“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,” 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.”

The two bills are among more than a half-dozen seeking to expand telehealth and telemedicine services and coverage, most often by loosening restrictions enforced by the Centers for Medicare & Medicaid Services.

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

Some bills have moved forward in fits and starts, while others seem to be foundering. The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 (S. 870) passed Senate Finance Committee approval back in May, though a recent Congressional Budget Office analysis noted the bill would increase telemedicine spending in the short term before driving down expenses. Late word out of Washington this week, however, indicates the senate may be ready to move the bill forward.

Meanwhile, the widely-praised and supported Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2017 (S. 1016) has apparently stalled in committee, and the Veterans E-Health & Telemedicine Support (VETS) Act of 2017 (S. 925) is apparently on a slow track while VA officials consider other methods for increasing telehealth and telemedicine services for the nation’s veterans.

There’s no guarantee that any of the bills will complete the journey to law. Some telehealth and telemedicine advocates have expressed doubts that any will make it through an increasingly overloaded and divided Congress.

Some advocates are hoping one or a few of these bills will be tacked onto more urgent legislation, such as bills supporting Medicare extender programs or CHIP funding.

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