Success of Telehealth Seen Tied to Medicare Reimbursement

Senator Roger Wicker (R-Miss.), chair of the Senate Subcommittee on Communications, Technology, Innovation, and the Internet, will reintroduce a bill to waive Medicare restrictions on telehealth services, encouraging greater use of the technology.


Senator Roger Wicker (R-Miss.), chair of the Senate Subcommittee on Communications, Technology, Innovation, and the Internet, will reintroduce a bill to waive Medicare restrictions on telehealth services, encouraging greater use of the technology.

According to Wicker, many barriers to telehealth exist outside the realm of communications. Wicker, along with Senator Thad Cochran (R-Miss.), will co-sponsor the Telehealth Enhancement Act aimed at “improving Medicare reimbursements and working toward payment parity,” he told an April 21 subcommittee hearing on telehealth advancements.

Also See: CMS Expands Telehealth Coverage under New ACO Model

As part of the bill, Medicare home health payments would be adjusted enabling patients to have access to nearby services through remote monitoring technologies, and extending telehealth coverage to all critical access and sole-community hospitals regardless of metropolitan status. Currently, Medicare policy prohibits reimbursing for telehealth services if the patient is not located in a rural area.  

In addition, Medicare will not currently reimburse for telehealth services if patients are located at home. The proposed legislation would cover more home-based video services for hospice care, home dialysis and homebound seniors if their residence is conducive to such technology.

“Health policy is driven by what is and what is not reimbursed. Medicare has to lead the way,” said ranking member Senator Brian Schatz (D-Hawaii). “The market share of Medicare is tremendous and the impact of payment reforms in Medicare are far-reaching. Innovative markets including mobile technology could be unleashed if Medicare were to step out and reimburse more extensively for telehealth services.”

The American Telemedicine Association endorses the Telehealth Enhancement Act. CEO Jonathan Linkous, testified before the subcommittee that private payers in about 25 states are now mandated to reimburse and Medicaid programs in about 45 states reimburse for telehealth services. “The one holdout, the one laggard, the one late adopter of the technology is Medicare,” said Linkous.   

Joel White, executive director of Health IT Now, a coalition of patient groups, provider organizations, employers and payers that supports incentives to deploy health IT, said his organization is thrilled with the bipartisan support telehealth received this week and believes use of technology can lower costs, which “should be taken into consideration when developing reimbursement rates for services provided via telehealth.”

However, Senator Gary Peters (D-Mich.) noted that the Congressional Budget Office (CBO) and other healthcare analysts are concerned thatchanging reimbursement policy could “open up the floodgates” on Medicare spending with a “rapid escalation of costs that will be difficult to handle.”

But, Chris Gibbons, M.D., assistant professor of medicine at Johns Hopkins University and a scholar-in-residence at the Federal Communications Commission, called the CBO assessment “an uninformed perspective” and countered that “the science and the evidence simply doesn’t support that contention.”

Similarly, Kristi Henderson, chief telehealth and innovation officer at the University of Mississippi Medical Center, testified that with “over 12 years of experience in this we’re seeing lower costs and improved health outcomes,” adding that “if you advance the legislation at a national level we’ll see the same benefits and cost savings.”

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