In its proposal to overhaul the Medicare Shared Savings Program, CMS is planning to reimburse for more telehealth and telemedicine services as it looks to revamp the Accountable Care Organization model.

By Eric Wicklund

– A federal effort to revamp the rules around Accountable Care Organizations includes a few nods to telehealth and telemedicine, giving healthcare providers hope that connected care platforms will become more prominent in an overhauled Medicare Shared Savings Program.

In a proposed rule published late Thursday, the Centers for Medicare & Medicaid Services (CMS) announced that it wants to begin reimbursing Next Generation ACOs this year for some store-and-forward (asynchronous) teledermatology and teleopthalmology services under the Telehealth Expansion Benefit Enhancement waiver.

In addition, CMS is proposing expanding coverage in 2020 for some telehealth and telemedicine programs in its Medicare Shared Savings Program that are delivered in areas that aren’t designated as rural or shortage zones. Medicare reimbursements have long been limited to programs in rural regions are parts of the country with a demonstrated shortage of healthcare providers.

In an article in Health Affairs, CMS Administrator Seema Verma said the overhaul, which renames the MSSP as the “Pathways to Success” program, aims to save Medicare $2.2 billion over the next decade.

“CMS believes that ACOs are promising – ACOs can, should, and must provide value for patients and taxpayers,” Verma wrote. “We are proposing significant changes to increase quality for patients and drive towards program-wide savings.”

“In Pathways to Success, CMS proposes several major changes which leverage new CMS authorities under the Bipartisan Budget Act of 2018,” Verma said. “These changes include allowing physicians and other practitioners that are taking performance risk to receive payment for expanded telehealth services. Physicians could receive payment for certain telehealth services regardless of the patient’s geographical location, including for services furnished to beneficiaries at their home, in order to expand access to high-quality services at a low cost.”

The connected care changes are relative morsels in a 600-page proposed rule whose primary goal, CMS officials said, is to accelerate the move of Medicare ACOs to downside financial risk arrangements that hold the organizations accountable for financial losses and promote competition.

“President Trump has promised the American people better healthcare at a lower cost, and delivering this kind of value is a key priority for HHS,” Health and Human Services Secretary Alex Azar said in a CMS press release.  “One piece of our vision for value-based transformation is pioneering bold new payment models. Having more Accountable Care Organizations take on real risk, while offering them the flexibility they need to generate savings, is an important step forward in how Medicare pays for value.”

The proposal has so far drawn mixed reviews. While the National Association of ACOs predicted the overhaul would all but destroy the ACO model, the Health Care Transformation Task Force called it “an important step to promote value-based transformation and to push industry momentum forward.”

In a statement, American Hospital Association Executive Vice President Tom Nickels said Pathways to Success would “create barriers to entry in transitioning to value-based care.”

“While we acknowledge CMS’s interest in encouraging providers to more quickly move toward accepting risk, drastically shortening the length of time in which ACOs can participate in an upside-only model ignores the reality that providers are starting at vastly different points and will have vastly different learning curves when moving toward value-based care,” he said.

Comments on the Pathways to Success program will be accepted through mid-October.

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