Telehealth is not just a rural healthcare issue, Verma says

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The Centers for Medicare and Medicaid Services is intent on removing restrictions that prevent Medicare providers from leveraging telehealth services to improve health outcomes for beneficiaries.

Speaking at last week’s Alliance for Connected Care Telehealth Policy Forum for Health Systems, CMS Administrator Seema Verma pointed out that Medicare’s rules and governing statutes have often served as barriers to leveraging telemedicine.

However, with enrollment in Medicare Advantage eclipsing 20 million people last year, she said that the agency understands that it must embrace telehealth technology to reduce healthcare costs by lowering readmissions rates, as well as unnecessary hospital visits through better care coordination.

“Under a proposed rule released just a few weeks ago, in 2020, Medicare Advantage enrollees will have more options for receiving telehealth services beyond what is otherwise available in the traditional program,” Verma told the conference. “The proposed changes for Medicare Advantage are a major step towards expanding access to telehealth services because the rule would eliminate barriers for private Medicare Advantage plans to cover additional telehealth benefits for enrollees in MA plans.”

Also See: Medicare to expand beneficiary access to telehealth services

“Ultimately, whatever CMS is doing to promote telehealth, it’s really all about one thing—to foster innovation and protect and strengthen the Medicare program in order to deliver on its promise to our elderly and disabled populations,” Verma added.

While telehealth serves as a “lifeline” in rural areas of the country, she emphasized that the technology must be used to benefit Medicare beneficiaries in urban America as well.

“We want to make sure that people across the country can take advantage of telehealth—not just those in rural settings,” Verma said. “Every year, we’re adding new services to the list of what can be covered by Medicare via telehealth. This year, that includes prolonged preventive services, which includes wellness exams for patients with complex needs. But we can’t stop there.”

Last week, CMS released a report to Congress on telehealth utilization and future opportunities. The agency’s report made the case that while Medicare payment for telehealth services is limited to services that are furnished to beneficiaries located in originating sites in rural areas—or sites that are participants in certain federal telemedicine demonstration projects—there is “emerging evidence that telehealth can also help address problems of access to care in urban areas.”

In particular, the CMS report pointed out that the technology could help those urban areas with high concentrations of minority populations where access to providers and medical specialists may be inadequate or delayed.

“Current restrictions on eligible telehealth originating sites appear to be the greatest barrier preventing the expansion of Medicare telehealth services,” states the report. “The two most significant Medicare restrictions are: requiring the originating site to be located in certain types of rural areas and not allowing the beneficiary’s home to be an eligible originating site.”

However, Verma contends that telehealth can enable patients to become active members of the care continuum outside of a hospital setting and promotes long-term engagement between patients and practitioners.

“Using technology, a patient managing a chronic condition can connect more frequently with their care team from home and spend less time going to the doctor’s office,” she said. “There’s no reason today that seniors shouldn’t be able to use their smartphones to connect to their doctors—especially as it’s what patients want and need, and leverages today’s technology and innovation.”

The CMS report to Congress also cited an analysis of 2016 Medicare fee-for-service (FFS) data showing that nearly 90,000 beneficiaries utilized about 275,000 telehealth services, representing just 0.25 percent of the more than 35 million FFS Medicare beneficiaries included in the analysis.

“The data analysis found that if only 1 percent of Medicare’s face-to-face encounters were instead provided by telehealth, it would result in a 13-fold increase in telehealth delivery of healthcare within the program,” according to CMS.

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