Now is an optimal time to update Medicare policies by taking full advantage of telehealth technologies and lifting the restrictions on reimbursement that are holding back access to care for patients with chronic conditions.
That was the overriding message from providers who testified on Tuesday during a Senate Finance Committee hearing on Medicare policies that can improve care for patients with chronic diseases.
Specifically, witnesses voiced their support for a bipartisan Senate bill—the CHRONIC Care Act of 2017—designed to help Medicare beneficiaries living with chronic conditions by, among other provisions, expanding access to telehealth services.
John Lovelace, president of government programs and individual advantage as well as president of the insurance services division at UPMC, pointed out that current law “narrowly limits the types of services for which the Medicare program will provide reimbursement” and that “even in the Medicare Advantage program, plans are disincentivized from offering telehealth services because they must either be paid for through rebate dollars or incorporated into an additional enrollee premium charge.”
While Lovelace said UPMC understands the caution with which policymakers have to date viewed changes in the law for broader Medicare coverage of telehealth, he argued that the “positive impact that telehealth is likely to have for Medicare beneficiaries” cannot be denied and that UPMC is “encouraged” by the inclusion of expanded telehealth services for Medicare Advantage as part of the provisions of the CHRONIC Care Act.
Likewise, Lee Schwamm, MD, professor of neurology at Harvard Medical School and director of the Partners TeleStroke Network at Massachusetts General Hospital, testified on behalf of the American Heart Association and American Stroke Association, telling lawmakers that the groups support policies that would allow Medicare Advantage plans to use additional clinically-appropriate telehealth technologies.
In particular, he said they applaud the “common-sense provision” in the CHRONIC Care Act expanding Medicare’s coverage of stroke telemedicine, called telestroke.
“The clot-busting drug tPA and mechanical clot-retrieval devices are highly effective treatments for the most common type of stroke and significantly reduce stroke-related disability, but they must be administered as quickly as possible after symptoms start,” Schwamm testified. “Telestroke has been proven to increase the percentage of stroke patients who get tPA and get it faster.”
According to Schwamm, one recent study of four urban hospitals in Illinois with low treatment rates found that their utilization of tPA increased two to six times after telestroke services were implemented.
“Despite the proven benefits of telestroke, Medicare’s coverage of it is woefully outdated,” Schwamm charged. “The current Medicare policy of limiting coverage for telehealth services to those patients originating in only rural areas has hampered the development of sufficient telestroke coverage. The most significant step Congress could take would be to allow Medicare to reimburse for telestroke evaluations for patients regardless of their location, as the CHRONIC Care Act would do.”
In addition, he said that greater use of telestroke will also result in healthcare cost savings. Specifically, Schwamm noted that the Medicare and Medicaid programs could save as much as $1.2 billion over 10 years, even after the costs of providing more telestroke evaluations and more tPA treatments are factored in.
Senate Finance Committee Chairman Orrin Hatch (R-Utah), a sponsor of the CHRONIC Care Act, said that the legislation currently has 17 bipartisan co-sponsors and has been endorsed by numerous healthcare organizations.
“The bill includes a number of policies that would improve care for the chronically ill through increased use of telehealth by giving Medicare Advantage plans and certain Accountable Care Organizations enhanced flexibility to target telehealth services to Medicare patients with chronic conditions,” according to Hatch.
Stephen Rosenthal, senior vice president for population health management at Montefiore Health System and chief operating officer of the Montefiore Accountable Care Organization, applauded the ACO provisions included in the CHRONIC Care Act.
“Your proposal to expand the ability of ACOs to employ telehealth solutions is an excellent way to provide patient access to services to best manage their chronic disease. To serve our urban and rural populations faced with challenges of getting to office appointments, telehealth technology can be a successful alternative to being there,” Rosenthal told senators.
At the same time, Rosenthal urged the committee to consider expanding the definition of telehealth “to include audio-only and those modalities that allow communication between providers, care managers and patients in a seamless fashion, especially in low-income communities that may not have access to videoconferencing technology.”
The Senate Finance Committee has scheduled a mark-up of the CHRONIC Care Act for Thursday.
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