- A bill that would boost telehealth services for chronic care treatment is headed to a Senate vote after breezing through a committee review this week.
The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 (S.870), sponsored by Sens. Ron Wyden (D-Ore.), Mark Warner (D-Va.) and Johnny Isakson (R-Ga.), also got some good news from the Congressional Budget Office. The CBO gave the bill a favorable score in its preliminary cost estimate, saying it would neither add to nor decrease Medicare spending over the next decade.
The CHRONIC Care Act targets Medicare payment reform, a popular catchphrase in Washington D.C. these days. Its goal is to push Medicare costs down by improvement chronic disease management services and care coordination at home.
Among other things, it would:
- extend for two years the Centers for Medicare & Medicaid Services’ Independence at Home demonstration, which establishes home-based primary care teams for Medicare beneficiaries with multiple chronic conditions, and increase the cap on the total number of participating beneficiaries from 10,000 to 15,000;
- add the patient’s home freestanding dialysis facilities, without geographic restriction, to the list of originating sites for monthly telehealth assessments with a nephrologist, beginning in 2019, though Medicare would not provide a separate originating site payment if the service was conducted at home;
- eliminate geographic restrictions on telestroke consultation services, beginning in 2019, though the hospital where the patient is located and the location of the physician providing the telemedicine consult would not receive separate originating site payments;
- expand telehealth coverage under Medicare Advantage Plan B, beginning in 2020; and
- give Accountable Care Organizations more flexibility to use telehealth services.
The proposed legislation received unanimous support from the Senate Finance Committee this week, which sent it on to the full senate for a vote. Committee Chairman Orrin Hatch (R-Utah) even vowed to “get this bill through” in his closing remarks.
According to the CBO’s estimate, Medicare reimbursements for telestroke would likely boost spending by $180 million over the next decade, while adding telehealth to ACOs would cost about $100 million - $50 million to give ACOs more flexibility to use the technology, and $50 million to expand the ACO population to include beneficiaries with chronic conditions.
Adding telehealth to Medicare Advantage plans to meet the needs of chronically ill enrollees would add another $90 million, the CBO predicted, while providing access to MA special needs plans for vulnerable populations would add $123 million over the next decade.
According to the CBO, those increases would be offset by a projected $80 million in savings realized in Medicare Advantage plans through “increased convenience” for enrollees and an estimated $375 million saved with the expected elimination of the Medicare and Medicaid Improvement Funds.
The CBO estimate drew praise from the American Telemedicine Association, which noted the federal agency has been slow to support telemedicine-friendly legislation in the past.
The last time the CBO scored such a bill was 2001, when the agency signaled its support for section 1834(m) of the Social Security Act, which paved the way for Medicare coverage of telemedicine in healthcare settings in rural locations. ATA officials said that legislation actually did more harm than good, creating “longstanding barriers for Medicare telehealth coverage” through its definition of a rural area and restrictions on store-and-forward telemedicine, remote patient monitoring and telehealth delivered to the home.
The ATA is asking its members to lobby senators to support both the CHRONIC Care Act and the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2017 (S.1016), which was filed earlier this month.
That bill, sponsored by Sens. Brian Schatz (D-Hawaii), Ben Cardin (D-Md.), Roger Wicker (R-Miss.), Thad Cochran (R-Miss.), John Thune (R-S.D.) and Mark Warner (D-Va.), aims to remove roadblocks to telemedicine expansion in Medicare by giving providers the freedom to experiment with telehealth in alternative payment models and incentive programs and expand remote patient monitoring programs for chronic care, remote and underserved populations.
Wyden, the Senate Finance Committee’s ranking member, told Medpage Today the committee’s 26-0 vote to support the bill “sends a powerful message.”
“This is a formal recognition that this package of services - the focus on care at home, the focus on new technology, the expanded role for primary care and prevention, which inevitably leads to more non-physician providers - is the beginning of our push to update the Medicare guarantee,” he said. “That's why it's transformative."