The Centers for Medicare & Medicaid Services must include telehealth in value-based payment models and lift geographic restrictions on its use, a new brief published by the American Hospital Association argues.
Currently, the AHA points out, limited coverage remains a major hurdle to more robust adoption by providers. This, the brief says, is fueled in part by inaccurate estimates from the Congressional Budget Office of the cost of delivering care via telehealth. For instance, AHA says, when Congress green lit limited Medicare telehealth coverage in 2001, the CBO estimated that it would cost the program $150 million within five years. To date, however, the Center for Telehealth eHealth Law calculates that Medicare has spent $57 million on those efforts.
"Research and experience under the Medicare program suggest that policymakers' concerns about increased access to telehealth leading to increased spending may be overstated, particularly when weighed against the potential benefits in quality, patient experience and efficiency," the brief says. "In fact, when the right types of services are utilized at higher levels … cost is significantly reduced."
Those services, according to AHA, include the Hospital at Home program, which is geared toward elderly patients who cannot or will not go to the hospital. Statistics from Johns Hopkins Medicine, which developed the program, revealed a 32 percent drop in cost for care at home vs. traditional care, as well as a shorter mean length of stay.
CMS does allow for the use of telemedicine beyond its typical boundaries in its Next Generation Accountable Care Organization program, which American Well VP of Government Affairs Kofi Jones lauds as an opportunity to generate proof of effectiveness in a January post to The Health Care Blog.
"Telehealth offers the ability to offer on-demand availability, project care after hours, reduce travel time and expenses, and allows providers to quickly identify and address gaps in care," she says. "Combined with the high satisfaction rates telehealth has produced for its end users, Next Generation ACOs have before them a tool that will improve their ability to manage and empower their patients, and improve outcomes through greater touch points."
In a recent report on how states can control healthcare costs and improve care quality, the Center for American Progress touches on the role of telemedicine to achieve those goals while outlining barriers such as licensure and practice rules. The AHA brief notes that while most Medicaid programs cover some telehealth services, criteria for coverage vary between states.
CMS, via a recently revealed final rule, enables Medicaid managed care plans to use telemedicine to meet network adequacy standards outlined in the rule.
To learn more:
- here's the AHA brief (.pdf)
- read The Health Care Blog post