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Telemedicine Legislation Takes Aim at Chronic Kidney Disease

The latest telemedicine legislation to hit Capitol Hill this year looks to add telehealth to the treatment regimen for the estimated 30 million Americans affected by chronic kidney disease, especially helping those undergoing dialysis.

Source: ThinkStock

By Eric Wicklund

- The latest telemedicine legislation to appear on Capitol Hill seeks to make digital health a key component of treatment for chronic kidney disease treatment.

The Chronic Kidney Disease Improvement in Research and Treatment Act of 2017 (H.R. 2644), re-introduced last month by U.S. Reps. Tom Marino (R-Pa.), John Lewis (D-Ga.) and Peter Roskam (R-Ill.), would, among other things, loosen the restrictions on telemedicine to treat kidney patients in their homes.

It’s one of a growing number of bills filed this year that seek to make telemedicine and telehealth a more acceptable standard of care, often by relaxing Medicare and Medicaid guidelines to improve access and reimbursement.

Roughly 30 million Americans, or 15 percent of the adult population, are affected by chronic kidney disease. Of that number, more than 660,000 have kidney failure, and almost 470,000 are on dialysis. More than 193,000, meanwhile, have a functioning kidney transplant, which requires them to follow a very strict daily medication regimen.

According to the National Kidney Foundation, telemedicine offers a promising alternative to in-person care, most often delivered in a doctor’s office or dialysis clinic. Clinicians can remotely monitor a patient’s blood pressure and other vital signs, as well as offering resources for medication adherence and diet plans.

More importantly, nephrologists and nephrology nurses can coordinate care online with a patient’s primary care provider (a model now being used by the Indian Health Service) and interact at home with patients undergoing hemodialysis and peritoneal dialysis, offering on-demand care between regularly scheduled office visits.

Marino calls his bill “a step in the right direction to better understand the disease and find a cure.”

“This bill is aimed at improving the lives of those suffering with kidney disease by identifying barriers for transplantation and improving donation rates,” he said in a press release. “It also allows individuals with kidney failure the ability to retain access to private insurance and promotes access to home dialysis treatments.”

“Additionally, H.R. 2644 seeks to understand the progression of kidney disease and the treatment of kidney failure in minority populations and improve access to kidney disease treatment for those in underserved rural and urban areas,” the release stated.

Included in the bill are provisions to:

  • Have the National Academy of Sciences study Medicare’s payment structure for renal dialysis services, including analyzing whether adjustments are needed to foster the development of new technologies and therapies;
  • Improve access to home dialysis treatments via telehealth for those with end-stage renal disease, as long as that treatment is combined with in-person treatment; and
  • Ease Medicare restrictions on originating sites for telemedicine to allow kidney patients to receive treatment at home;

Medicare only began limited coverage of telemedicine for home dialysis in 2016, with the introduction of the 90963-90966 outpatient home dialysis codes, but those codes were limited in scope. Several organizations, including the American Medical Association and the American Telemedicine Association, have been leading the effort to add new codes and broaden existing ones by removing geographic and reimbursement barriers.

Aside from this latest bill, telemedicine for chronic kidney disease is also addressed in the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2017 and the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017.

The CHRONIC Care Act includes a provision to add the patient’s home and 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.

The CONNECT for Health Act, meanwhile, would incorporate provisions introduced in the CHRONIC Care Act, as well as expanding remote monitoring programs for people with chronic conditions and giving the Health and Human Services Department the leeway to ease barrier to telehealth expansion, provided quality and cost-effectiveness criteria are met.

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