Bill would give Medicare telehealth a much-needed shot in the arm

Six senators have re-introduced legislation that would enhance telehealth services in Medicare, action that is sorely needed and would prove beneficial for rural areas lacking access to specialty medicine.

The bipartisan bill is symbolic in that it also shines a light on Medicare’s ineptitude when it comes to covering telehealth services, trailing other health programs involving Medicaid and private insurers.

Medicare is under the federal government’s oversight and is the largest payer in the country. Usually the healthcare industry follows what Medicare does. Inactivity on its part is probably the No. 1 reason telehealth is not as broadly recognized as it should be.

Medicaid oversight is up to the states, and all 50 of them and the District of Columbia have some form of telehealth reimbursement on the books. It’s also up to the states to have rules in place for reimbursement of services from insurers, and the majority of them have at the least some basic telehealth guidelines in place.

State regulations have resulted in a patchwork telehealth system, but one that could be improved if Medicare had stronger rules in place. For example, there are three primary types of telemedicine applications—real-time communications, store-and-forward (acquiring and later transmitting clinical data), and remote patient monitoring—but Medicare covers just real-time audio and video. Also, Medicare generally does not pay for telehealth services in urban facilities or in a home setting.

A report published by the Government Accountability Office in April 2017 found that less than 1 percent of Medicare beneficiaries received care through telehealth, basing the findings on 2016 data from the Medicare Payment Advisory Commission.

The senators backing the CONNECT Act have re-introduced it and feel encouraged about the prospects this time around. The legislation takes action on several fronts, but largely it increases the latitude of patients, providers and insurers to engage in telehealth without fear of not being properly reimbursed or covered by Medicare.

Specifically, the bill would:

  • Expand the use of telehealth in accountable care organizations and Medicare Advantage, as well as for home dialysis patients and acute stroke evaluations;
  • Expand the use of remote patient monitoring for chronic conditions;
  • Increase telehealth remote patient monitoring services in community health centers and rural health clinics, Native American sites, and in global and bundled payments;
  • Provide direct authority to the U.S. Health and Human Services secretary to lift existing restrictions on telehealth when certain quality and cost-effectiveness criteria are met; and
  • Expand the use of the technology in mental health services.

The expansion of patient monitoring is key, as that is one of the main tenets of telehealth correspondence. Cardiac, respiratory and neuro monitoring devices are just a few of the home health medical devices that could be covered by Medicare if the bill passes.

In addition, the Senate also recently re-introduced the CHRONIC Care Act, which would allow coverage of telehealth assessments for Medicare beneficiaries on home dialysis.

These pieces of legislation are a step in the right direction, as any significant additions to telehealth in Medicare is a bonus for not only the technology, but the healthcare community as a whole.

For more information telemedicine and health information technology, refer to the Decision Resources Group Market Overview and Health Plan Analysis reports. Find out more: Health Plan Analysis. Market Overviews.

Chris Silva is a senior analyst at DRG and specializes in information technology, telehealth and big data, among other topics. Follow him on Twitter at @ChrisSilvaDRG.