- The structure of Medicare reimbursements is limiting the ability of accountable care organizations (ACOs) to engage in telemedicine, say the Alliance for Connected Care (ACC) and a coalition of other telehealth advocate groups in a series of letters written to newly confirmed HHS Secretary Sylvia Mathews Burwell. In order for ACOs to take advance of the opportunities telemedicine has to offer, including increased care coordination, expanded access, and more robust patient engagement, providers need to be able to bill for their services appropriately and make the investments in telehealth infrastructure worthwhile.
Medicare currently only reimburses telehealth services under limited services, points out the ACC and the Patient and Provider Group Advisory Board in their letter. Only those beneficiaries able to reach an “originating site” in an area designated as a Health Professional Shortage region or one that exists outside a Metropolitan Statistical Area can be reimbursed for remote care, leaving other Medicare patients unable to benefit from telehealth services.
An additional letter, signed by major groups such as the American Telemedicine Association (ATA), HIMSS, and Personal Connected Health Alliance (PCHA), notes that 80% of Medicare beneficiaries do not meet these restrictive definitions and therefore have no access to telehealth care. Remote monitoring may save the United States up to $27 billion by 2018, a recent study found, which would be consistent with HHS’s overarching mission of trimming costs from the bloated healthcare system.
“For ACOs, the existing statutory and regulatory frameworks hinder their ability to manage care and treat their beneficiary population in less costly care settings,” the ACC letter adds. “These barriers are also counter to the Medicare Shared Savings Program’s (MSSP) goal of ACOs having the ability to coordinate care using telehealth, remote patient monitoring, and other such enabling technologies.”
The groups ask Burwell to invite public comment on changes to the MSSP that would encourage greater use of telehealth and waive the current restrictions on telehealth reimbursement to allow ACOs to be reimbursed for remote care. This could remove the “disincentive” for the majority of ACO providers who wish to use telehealth technology to increase the scope and depth of their care abilities. “Those of us working with providers who do not receive reimbursement for connected care services are faced with the difficult decision of assuming financial risk by providing the care for free,” the ACC points out. “For many physician-led and smaller ACOs without access to a lot of capital, it is not even an option.”
“We believe that regulations and policies should reflect the dynamic and transformative nature of advanced information and communications technology solutions, and should not stifle innovation that can continually improve patient care,” states the ATA and associated groups. “We encourage you to take a technology-neutral approach towards a fully-connected health IT ecosystem that embraces the diversity of solutions that allow for innovative improvements in care that technology can provide at each state along the continuum of care.”