American Heart Association seeks Medicare coverage of telehealth

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The American Heart Association is backing the use of telehealth services for heart disease and stroke, saying that medical evidence backs the clinical effectiveness of its use and saying the services should be covered by Medicare.

The national organization issued a Dec. 20 policy statement backing the position, including a series of recommendations on implementing various forms of telehealth for cardiovascular and stroke care.

The statement comes as telemedicine approaches gain new support to treat a variety of conditions, especially as the healthcare industry shifts to value-based care. In addition, recent legislation passed by Congress asks for additional inquiry into how Medicare can make use of telemedicine for beneficiaries.

Specifically, the 21st Century Cures Act asks the Centers for Medicare and Medicaid Services to examine current and potential uses of telehealth in the program to reassess how Medicare should cover those services. Currently, Medicare pays only $17.6 million annually for such services, out of total program expenditures of $646 billion.

Also See: Why Medicare needs to increase payments for telehealth

The possible expanded reimbursement of telehealth for Medicare beneficiaries would have the potential to greatly increase payments by the program for remote and virtual care. The heart association estimates that cardiovascular disease and stroke cost the U.S. healthcare system more than $320 billion and $33 billion, respectively, each year, with the cost for treating the two conditions expected to rise to nearly $1 trillion annually by 2030.

The position statement, published in Circulation, the AHA’s online journal, provides a review of scientific evidence that evaluate the use of telemedicine in cardiovascular and stroke care “and to provide consensus policy suggestions,” an abstract notes. The result of the review “is designed to promote telehealth models that ensure better patient access to high-quality cardiovascular and stroke care while striving for optimal protection of patient safety and privacy.”

The policy statement is the second such effort by the heart group to provide medical evidence to support the use of telehealth in treating conditions. In 2009, it issued a telestroke policy that contained recommendations for implementing the use of telemedicine within systems of care for stroke. The new policy takes that a step further, pointing to evidence and approaches that suggest the Medicare program consider reimbursement for telehealth services.

“Telehealth is not only a proven tool for increasing access to high quality cardiovascular and stroke care for many patients, but it also meets all of the National Academy of Medicine’s domains of quality,” says Lee Schwamm, MD, who was the lead author for the policy statement. “It is recognized as safe, timely, effective, equitable, efficient and patient-centered care. With increasing physician shortages, rising costs and a burgeoning demand for treatment, telehealth can greatly improve value in healthcare and, most importantly, produce better health outcomes.”

However, the professional group notes that many legal and regulatory barriers have hampered the use of telehealth in treating cardiovascular disease and stroke patients. “Currently, payment by Medicare for telehealth services for CVD patients is only available if you live in rural areas of the U.S. and where real-time communications are available,” it notes. Other obstacles include the lack of private insurance coverage for telehealth, the lack of interstate medical licensure, ensuring healthcare professionals can master the digital learning curve and costs associated with the technology.

“Our healthcare system must continue to adapt to take full advantage of proven forms of treatment, like telehealth, that can effectively fight these deadly diseases and advance healthcare quality,” says Nancy Brown, CEO of the American Heart Association.

The association’s policy statement makes several recommendations to effectively utilize telehealth in cardiovascular and stroke care, with the key proposal being that Medicare should provide benefits coverage for all evidence-based telehealth services for cardiovascular and stroke care. The association recommends that coverage and payment parity exist across all states, ensuring that insurers and others offer and cover specific, proven evidence-based telehealth interventions.

Other recommendations to overcome barriers to telehealth include:

  • Ensuring that all properly trained providers are deemed eligible providers for telehealth interventions, without restricted networks that would limit reimbursement by provider.
  • Encouraging the development of simpler, less expensive technology platforms that enable inter-operability between systems limiting patient burden and costs for healthcare systems.
  • Ensuring that large electronic health record systems incorporate telehealth and make it compatible with traditional health records to promote a single integrated health record for all patients.
  • Encouraging the development of improved education for providers to simplify the process of delivering telehealth and increase adoption among providers.
  • Ensuring that adoption of telehealth does not sacrifice quality in the name of cost savings, such as by restricting patient access to limited networks of telehealth specialists rather than in-person specialty care, and promotes high quality care delivery.
  • Investing in additional research to determine the cost-effectiveness of new telehealth interventions.

The heart group’s policy statement can be accessed here.

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