Telehealth bill brings reimbursement debate to center stage

Disagreements about how to pay for telemedicine have hampered its use for years. Now, a bipartisan telehealth bill, co-sponsored by Sen. Brian Schatz (D-Hawaii), has widespread support from across the industry.

The forces may be aligning to expand reimbursement for telehealth—or at a minimum, to increase a national discussion on the issue.

The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, proposed February 3 by Sen. Brian Schatz (D-Hawaii), has strong bipartisan support and would expand Medicare telehealth services, improve care outcomes and help cut costs for patients and providers. Other bill sponsors include Senators Ben Cardin (D-Md.), Thad Cochran (R-Miss.), John Thune (R-SD), Mark Warner (D-Va.), and Roger Wicker (R-Miss.),

The fact that telehealth has been crafted is not unusual; Congress has seen legislation offered in years past. What is unusual is the breadth of support for the bill—it has 67 professional organizations lining up in favor of it, including AARP, American Health Insurance Plans, the American Heart Association and Kaiser Permanente, to name a few.

There is pressure on the Hill to pass a budget-neutral bill, and because of those limitations, some groups say the bill doesn’t go far enough.

Although the bill isn’t ideal, it will encourage a much-needed national dialogue on the value of telehealth, said Leslie Krigstein, vice president of congressional affairs for the College of Healthcare Information Management Executives (CHIME).

“We’ve often heard from CIOs that adoption of telehealth and remote monitoring technologies has been limited, not by technical restraints, but by policy barriers,” she said.

CHIME’s “dream” bill would include wide-scale reimbursement expansion, while also alleviating other policy barriers to telehealth proliferation, including cross-state licensure and inconsistencies in the definition of telehealth services, Krigstein said, while acknowledging that legislation that included these measures would come with a hefty price tag.

Krigstein said the bill is well-suited for consideration by the Senate Chronic Care Working Group, and she believes that initial consideration there will improve its potential to advance in the Senate.

Gary Capistrano, chief policy officer at the American Telehealth Association (ATA) called the bill “a very sensible, budget-sensitive package.” ATA strongly supports the bill, Capistrano said, while also acknowledging “there’s always more” that could be included.

One of the best parts of the bill is that it allows telemedicine reimbursement for the 17 million Medicare Advantage beneficiaries, Capistrano said. This is a good first step and lends hope to ATA and other stakeholders who would like to see future legislation include reimbursement under Medicare fee-for-service.

The House has proposed a companion bill, the CONNECT for Health Act (HR 4442), sponsored by Rep. Diane Black (R-Tenn.), also with bipartisan support and currently under consideration by two committees. Co-sponsors for that legislation includes Representatives Gregg Harper (R-Miss.), and Peter Welch (D-Vt.).

Supporters of the Senate bill, including ATA, are eager to see how the Congressional Budget Office scores the bill for its budget impact, which will determine which measures will stay and which will go, said Capistrano.

Other telehealth bills on the table may become part of the mix, Capistrano aid. One such bill is the Medicare Telehealth Parity Act, sponsored by Representatives Mike Thompson (D-Calif.) and Gregg Harper (R-Miss.), which proposes to put Medicare on the path toward parity with in-person healthcare visits.

A new analysis by Avalere Health estimates that policy changes included in the Senate bill to expand Medicare reimbursement of telehealth and remote patient monitoring (RPM) would collectively decrease federal spending by $1.8 billion between fiscal year 2017 and fiscal year 2026.

The current telehealth bills on the table provide some good opportunities to fund reimbursement for remote patient monitoring, an area where “Medicare is hemorrhaging,” Capistrano said. But regardless of which telehealth bill gets through Congress, “the important thing is to keep moving,” he said.

Industry support at this time is crucial, because telehealth is a largely untapped innovation that needs more support from healthcare organizations, says Justin Barnes, principal at Justin Barnes Advisors, who has played an active role in leading telehealth policy on behalf of various industry and care provider groups for more than a decade.

Not only will the bill help expand telehealth into every community, it also will help providers navigate the value-based care reimbursement model set up in the Medicare Access and CHIP Reauthorization Act (MACRA) regulation, Barnes said.

The American Medical Association (AMA) said the legislation has the potential to remove barriers to new healthcare delivery models that promote coordinated and patient-centered care.

"This bill shows Congress at its best – combining deep thinking, hard work, compromise and bipartisanship. In the end, the bill could improve health outcomes and save money,” AMA President Steven Stack, MD said in a statement

Pete McLain, senior vice president of healthcare at Yorktel, a telehealth solutions provider, said the bill will give providers the ability to reach into other geographical areas with virtual services. “The added competition should mean more options and choices for patients, which should lead to a greater quality of care," he said.

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