Labeling telehealth as “increasingly vital” to the healthcare delivery system, the American Hospital Association (AHA) urged the Committee on Energy and Commerce to reduce Medicare’s financial and technological barriers to remote care.  The letter, addressed to Chairman Fred Upton,follows a report on the growing promise of telehealth to address care disparities, reduce costs, and ease packed calendars for physicians who can easily diagnose and treat certain low-level conditions without the need to see a patient face-to-face.

“Despite recent expansions in covered services, Medicare is behind the private sector and many state Medicaid programs in promoting telehealth,” writes AHA Executive Vice President Rick Pollack.  While many states have established parity laws that require Medicaid to cover telehealth services in the same way as private payers do, Medicare has not embraced video and telephone consults in the same way. “Medicare Advantage plans are beginning to provide telehealth benefits that are not covered under Medicare fee-for-service (FFS) rules, leaving the 70 percent of those utilizing FFS with limited access to these technological advances,” Pollack points out.

The expansion of telehealth faces several distinct obstacles, including geographic restrictions that dictate where a patient must be located in order to qualify for telehealth care.  Currently, patients must live in a qualified rural Health Professional Shortage Area, which ignores the needs of urban populations that make up the majority of Medicare beneficiaries.  In 2013, patients in 97 counties lost access to Medicare’s telehealth services when their areas were redefined as “metropolitan” instead of rural.

“We know that urban areas (particularly inner cities) can also suffer physician shortages, and access to certain specialties (such as psychiatry) can be limited in all geographic areas,” Pollack says. “Further, the almost ubiquitous use of communications technology in American life today has created growing consumer expectations that, where safe and appropriate, health care services also can be accessed remotely, regardless of where the individual is located.”

Medicare also narrowly defines what technologies and services will be covered for reimbursement.  It will not pay for store-and-forward technology, nor will it provide reimbursement for many common treatment options. “In 2015, only 75 individual service codes out of more than 10,000 physician services covered through the Medicare physician fee schedule are approved for payment when delivered via telehealth. This constrained list stands in stark contrast to the private payers operating in telehealth parity states,” the letter says.

A discussion draft outlining potential ways to improve Medicare’s telehealth structure does not go far enough in reducing these obstacles, the AHA says.  The draft proposes that Medicare expand its telehealth services only if doing so would not add costs to the system, which may not take into account future savings generated by better primary care and sustained patient engagement with the healthcare system.  The draft does not address the technology limitations inherent in the current rule structure, and may not be able to adapt and evolve as quickly as the technology is currently doing.

The American Telemedicine Association has also weighed in on the draft, and sees similar problems with the cost containment strategy.  “We understand the present political requirement that proposals must not cause a net increase to Medicare spending and do not object to the inclusion of some form of it,” writes ATA CEO Jonathan Linkous. “However, we are concerned that the no spending increase test and process of certifying could be too rigorous to ever be conclusive and result in an endless economic debate and no action.”

“You might also consider alternative means, such as to create a role for Congress’s Medicare Payment Advisory Commission in certifying that any use of telehealth generates no additional costs or offsetting savings,” Linkous adds.

“In conclusion, the AHA strongly agrees with your goal of expanding coverage of telehealth services in Medicare, and appreciates the specification of a mechanism for doing so,” Pollack said. “However, given the growing body of evidence that telehealth increases quality, improves patient satisfaction and reduces costs, we believe a more global approach to expanding Medicare coverage of telehealth is warranted.”

The post Medicare Must Embrace Telehealth, Reduce Barriers to Care appeared first on mTelehealth.

In addition to providing definitions for telemedicine (two-way audio video communications, including video conferencing) and telehealth (telephone and remote patient monitoring), the new law defines the scope of eligible distant site providers to include not just physicians, physician assistants, and hospitals, but also dentists, home care and hospice agencies, nurses, midwives, podiatrists, optometrists, ophthalmic dispensers, psychologists, social workers, and speech language pathologists and audiologists.

Although the law does not place any restrictions on the site at which a patient is located at the time telemedicine or telehealth services are provided, it permits insurers to delineate appropriate settings for such services.

In order for telemedicine services to be covered the services must meet the requirements of federal law, rules and regulations for Medicare, except with respect to originating site restriction requirements.  Telehealth services will be covered if they are consistent with the conditions set forth in Section 3614(3-c) of the Public Health Law, which governs home telehealth services.

Finally, the law adds telemedicine and telehealth as a covered Medicaid benefit, and expressly precludes the Commissioner of Health from eliminating Medicaid payment for such services, subject to the approval of the Budget Director.

Although the new law casts a wide net with respect to the definition of eligible providers, it will be interesting to see how insurers reconcile this with Medicare’s more restrictive scope, since many of the telemedicine services covered under the New York law, including dental, podiatric, optometry and home health services, are not covered under Medicare. In the meantime, the governor has already agreed to chapter amendmentswhich will be introduced to address, among other things, the scope of telehealth services and certain limitations on telehealth coverage.

The post New York Passes Telemedicine Reimbursement Legislation appeared first on mTelehealth.

The post Telehealth/ Telemedicine: An Opportunity for Physicians and Providers to Add a New Line of Service appeared first on mTelehealth.

A new bill that aims to provide additional incentives for accountable care organization successes includes several provisions that would allow ACOs to expand their telemedicine efforts.

Under the bill, ACOs would not be limited by many originating care site restrictions and would be permitted to use store-and-forward telemedicine. The bill would also permit ACOs to engage in remote patient monitoring to better track high-risk patients.

The bill’s sponsors, Diane Black (R-Tenn.) and Peter Welch (D-Vt.) hope the bill will encourage ACOs and help facilitate the transition to value-based reimbursement. “It is unfortunate that the current fee-for-service payment system does little to encourage and incentivize providers and patients to use the most appropriate and effective healthcare options,” said Rep. Black. “By incentivizing providers to focus on improving healthcare outcomes instead of increasing the quantity of services provided, this legislation will help improve care coordination, increase efficiency and mostly importantly, ensure the patient receives the best care possible.”

The post House Bill Would Allow ACOs To Expand Use of Telehealth Services appeared first on mTelehealth.

September 11, 2014 | By Katie Dvorak
There are many uses for telemedicine to manage chronic diseases, and no matter the process, the technology offers beneficial results and costs reductions, according to a recent study.

The study, published online in the journal Telemedicine and e-Health, looks at the impact telemedicine has on cost, quality and access to care, focusing three chronic diseases: congestive heart failure, stroke and obstructive pulmonary disease.

The authors, which include former American Telemedicine Association President Rashid Bashshur (pictured)–executive director of eHealth at the University of Michigan Health System–found that for each chronic disease, a different telehealth approach was needed.

• Congestive heart failure: Long-term telemonitoring support is the most efficient and effective model for disease management
• Stroke: Telestroke has the most impact–prompt interventions aimed at optimal treatment. According to a 10-year evaluation, telestroke units helped increase the number of rural patients treated and deliver treatment faster over 10 years
• CPOD: Telepulmonology is the best treatment, using remote measurement of lung function through telespirometry and teleconsultations between care providers, pulmonary specialists

Because of the different types of telemedicine used for each chronic disease, the study’s authors said a “homogeneous telemedicine landscape now or in the future is beyond reasonable expectation.”

However, the authors said telemedicine shows many benefits in the care of chronic diseases. There were reductions in services, with re-admissions and length of hospital stay declining, and “there often were reductions in mortality,” they said.

The use of telemedicine also allows patients to be more engaged in managing their own health, according to the authors.

To that end, most patients are embracing the use of video appointments and care through telemedicine, according to a recent study also published in Telemedicine and e-Health.

In addition, costs are also reduced because of avoidance of unnecessary services, the authors said. Recent analysis from Towers Watson found telemedicine could save U.S. companies hundreds of millions, if not billions, of dollars in costs.

To learn more:
– check out the study (.pdf)

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The post Medicare Telehealth Parity Act of 2014 appeared first on mTelehealth.

Services to be covered when provided by telehealth:

Chronic Care Management

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CMS is proposing reimbursement criteria for non-face-to-face chronic care management (CCM) services, defined as a unique, covered service designed to pay separately for non-face-to-face care coordination services furnished to Medicare beneficiaries with two or more chronic conditions. CMS discussed this new policy in 2013 but did not include a specific reimbursement proposal.

The specific code for this service (tentatively called GXXXI) is defined as:

“Chronic care management services furnished to patients with multiple (two or more) chronic conditions expected to last at least 12 months, or until the death of the patient, that place the patient at significant risk of death, acute exacerbation/decompensation, or functional decline; 20 minutes or more; per 30 days”

A payment rate of $41.92 could be billed no more frequently than once per month per qualified patient.

Eligible CCM services MUST be furnished with the use of an electronic health record or other health IT or health information exchange platform which includes an electronic care plan that is accessible to all providers within the practice, including being accessible to those who are furnishing care outside of normal business hours and is available to be shared electronically with care team members outside of the practice.

The mTelehealth Remote Patient Monitoring Solution’s clinical platform meets or exceeds all of the above conditions.  Any accounts that have physicians or eligible Part B providers that use the mTelehealth Remote Patient Monitoring Solution platform for chronic care management of patients meeting the criteria listed can bill Medicare $41.92 per user/subscriber on a monthly basis, offsetting the monthly service cost. This is a clear and direct ability for providers to get paid for using our mTelehealth platform.

Since this new code GXXXI is covered when provided by telehealth for non face-to-face management and carries its own set of unique criteria, it is a separately identifiable service from 99339, or 99374 (NOT considered “telehealth” or “telemedicine” by CMS) and can be billed separately for qualifying patients.

Another example of this is examined in the following article:

The post CMS to Begin to Pay for Remote Patient Monitoring in 2015 appeared first on mTelehealth.

The post House Bill Seeks to Phase in Medicare Coverage of Telemedicine, Remote Patient Monitoring appeared first on mTelehealth.

The post Why Remote Monitoring Services are Poised for Explosive Growth appeared first on mTelehealth.

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