While telehealth and remote patient monitoring can help improve healthcare outcomes for Medicare beneficiaries, payment and coverage restrictions are creating barriers that are hampering the utilization of these technologies.

That’s the core finding of a new audit by the Government Accountability Office.

Auditors reported that Medicare providers use telehealth services for a small proportion of beneficiaries and relatively few services. And, when it comes to remote patient monitoring, the GAO said the number of Medicare beneficiaries who use this service is unknown due to insufficient data.

The Medicare Access and CHIP Reauthorization Act of 2015 included a provision for GAO to study telehealth and remote patient monitoring. Toward that end, GAO auditors interviewed representatives from nine stakeholder associations—six provider, two patient, and one payer association—in putting together their report to congressional committees.

“With regard to factors that create barriers, the selected associations most often cited concerns over payment and coverage restrictions,” states the GAO’s report. “Officials from a provider association reported that Medicare’s telehealth policies for payment and coverage lag behind other payers due to the program’s statutory and regulatory restrictions. In particular, these restrictions limit the geographic and practice settings in which beneficiaries may receive services, as well as the types of services that may be provided via telehealth and the types of technology that may be used.”

Further, officials from another provider association described coverage as the single greatest barrier to the use of telehealth, adding that Medicare’s restrictions on the types of services covered by the program have prohibited its broader use. When it comes to remote patient monitoring, officials from another provider association stated that Medicare’s valuation methodology for services results in low payment rates for remote patient monitoring, which these officials said remains a principal barrier to the use of these services.

Similarly, infrastructure requirements were called out as a “very significant or somewhat significant” barrier to the use of both telehealth and remote patient monitoring in Medicare. For example, officials from one provider association and both patient associations interviewed by auditors described access to sufficiently reliable broadband Internet service as a barrier to telehealth use.

Likewise, officials from both of the patient associations also mentioned the ability to access the technology necessary to use telehealth as a potential barrier to its use, while officials from two of these provider associations also described uncertainty around which remote patient monitoring products and services are most effective.

“Congress wanted more information before moving forward on removing restrictions on Medicare telehealth coverage. They got a good overview on federal use of telehealth and a fuller picture on what a laggard Medicare is,” says Gary Capistrant, chief policy officer at the American Telemedicine Association.

Earlier this month, a bipartisan group of senators reintroduced a bill seeking to improve health outcomes for Medicare beneficiaries living with chronic diseases by, among other provisions, expanding access to telehealth services. The Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 contains major telehealth provisions targeted at patients with chronic conditions, including expanding the ability of home dialysis beneficiaries to receive required monthly clinical assessments using telemedicine.

Also See: New bill would expand beneficiaries’ access to telehealth

The GAO noted in its report that under the new Merit-based Incentive Payment System clinicians can use telehealth and—in some instances—remote patient monitoring to help meet the payment program’s performance criteria. In addition, auditors referenced the fact that Congress in the 21st Century Cures Act called for expanding the use of telehealth in Medicare through increasing the types of sites where telehealth can occur.

“While Medicare currently uses telehealth primarily in rural areas or regions designated as having a shortage of health professionals, in the future emerging payment and delivery models may change the extent to which telehealth and remote patient monitoring are available and used by Medicare beneficiaries and providers in other areas,” according to the GAO.

Previously, the Congressional Budget Office has expressed concerns that changing Medicare reimbursement policy regarding telehealth could dramatically increase healthcare spending. However, Capistrant believes the CBO’s concerns about the potentially negative cost impacts of removing barriers to utilizing telemedicine in Medicare are unfounded.

“The major story is that there is not a major story. The concerns of skeptics were again shown to be baseless,” adds Capistrant. “We hope that Congress will stop asking for studies and soon include expanded Medicare coverage of telehealth, especially for the Medicare Advantage and other plans bearing the full financial risk for the cost of care.”

GAO auditors provided a draft of their audit to the Department of Health and Human Services and the Centers for Medicare and Medicaid Services, which oversees Medicare payments for telehealth services. However, CMS officials were not immediately available for comment on the GAO’s report.

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