Telehealth has the potential to help rural patients remotely access specialized healthcare that's often only available to those in large metropolitan areas — but convincing payers like Medicare to cover these services has proved challenging.
Section 1834(m) of the Social Security Act, for example, established restrictions on reimbursement for telehealth and remote patient monitoring services under Medicare fee-for-service. The program limits telehealth coverage to certain rural regions predetermined by HHS, which are designated eligible originating sites. Current Medicare Advantage Plans classify telehealth as a supplemental benefit, but patients who receive these services may pay higher premiums, additional co-pays or from the plans' rebates, according to the Center for Connected Health Policy.
Many healthcare advocacy organizations say the statute is due for reform and have rallied around recent legislation like the Creating Opportunities Now for Necessary and Effective Care Technologies for Health Act of 2017. The bipartisan bill, authored by Sen. Brian Schatz, D-Hawaii, and nicknamed the CONNECT for Health Act, was introduced May 3.
The CONNECT for Health Act has garnered bipartisan support, posting 13 cosponsors and more than 50 endorsements from advocacy groups like the American Medical Association, the American Telemedicine Association and the Healthcare Information and Management Systems Society. One of its many supporters is the Alliance for Connected Care, a Washington, D.C.-based lobbying group.
"At the end of the day, if we're treating patients, it shouldn't matter how we treat them," says Mike Baird, CEO and founder of telehealth company Avizia and active member in the Alliance. "Unfortunately, some of these restrictions that are in place create disincentives toward the adoption of telehealth."
Groups like the Alliance for Connected Care argue telehealth effectively extends provider reach and expands patient access. However, current state-by-state telehealth legislation offers a confusing landscape for providers looking to engage with the emerging and in-demand method of healthcare delivery.
Mr. Baird says providers will need a consistent reimbursement framework to engage with telehealth, since current legislation "is a relatively confusing patchwork."
With certain restrictions, the CONNECT for Health Act would cover telehealth and remote patient monitoring as basic benefits in Medicare Advantage. The bill also proposes a bridge program to help providers report telehealth and remote patient monitoring practices under the Medicare Access and CHIP Reauthorization Act's Merit-based Incentive Payment System. It would expand the use of remote patient monitoring for chronic conditions and establish three new types of originating sites: telestroke evaluation and management, Native American health service facilities and dialysis facilities for home patients.
Currently, the HHS secretary can waive telehealth restrictions for fee-for-service at ACOs. The CONNECT for Health Act would also give the HHS secretary the authority to waive restrictions for fee-for-service at non-ACOs, should the department deem "[telehealth service] would maintain quality and decrease the cost, or maintain cost and increase quality," explains Krista Drobac, executive director of the Alliance for Connected Care.
But, the CONNECT for Health Act has been stuck in committee, and the Alliance for Connected Care isn't entirely sure about the bill's future.
The group's solution? To break the bill apart to push select reforms forward piece-by-piece.
"If the CONNECT for Health Act doesn't move in entirety on its own, we want to be sure that pieces of it get enacted as other bills," Ms. Drobac says.
One bill is the Chronic Kidney Disease Improvement in Research and Treatment Act of 2017 (H.R. 2644), which would strengthen federal research efforts, improve patient care and expand treatment access related to chronic kidney disease. The bill proposes expanding care options, including restricted access to at-home dialysis and other remote services.
Another bill, the Furthering Access to Stroke Telemedicine Act of 2017 (H.R. 1148), would provide reimbursement for Medicare beneficiaries who present at hospitals or mobile stroke units for remote neurological consults.
Ms. Drobac is hopeful about the legislation efforts, adding, "Policymakers now realize that telemedicine is for all Americans — rural, suburban and urban."
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