ATA: CMS must loosen telehealth rules, allow wider use in ACOs

Expect to hear lots of chatter at the ATA's 16th Annual International Meeting and Exposition about telemedicine's important role in accountable care organizations--and about how current regulations would inhibit it.

The American Telemedicine Association sent a six-page letter to CMS April 25, imploring Administrator Donald Berwick to waive five regulatory restrictions that would prevent ACOs from using telemedicine services to coordinate patient care, improve outcomes and save money.

While the Patient Protection and Affordable Care Act signed into law last year emphasizes that ACOs should use "telehealth, remote patient monitoring, and other such enabling technologies" to "promote evidence-based medicine and patient engagement, report on quality and cost measures, and coordinate care," the current Medicare rules are "riddled" with restrictions that would prevent this vision, the ATA points out in its missive.

For example, the current prohibition against using telehealth services for beneficiaries located in metropolitan areas would hinder stroke patients--among others--from engaging in a timely consultation with a neurologist (specialists who, too often, are hard to come by).

Thus, the ATA asked Berwick to make five specific changes:

  • Allow ACOs to use telehealth in urban areas.
  • Cover physical, occupational, speech and audio therapies when provided through telehealth technology. It's an important change for stroke, brain injury and other patients with mobility issues who have trouble getting to an inpatient setting for treatment, officials say.
  • Permit store-and-forward services in all 50 states. Right now, store-and-forward technology can only be used in federal telehealth demonstration programs in Hawaii and Alaska. ATA officials point out that some of the most mature telemedicine technology rests on store-and-forward imaging, including telehealth-enabled cardiology, diabetic retinopathy, wound management and dermatology.
  • Create new CPT codes for telehealth. ATA has suggested a set of 10 codes before, but been shot down by CMS. Now, however, with ACOs' pay hinging partly on patient outcomes, they need access to any and all services that they deem necessary to improve patient health, ATA officials insist.
  • Allow telehealth services to originate somewhere other than the hospital. The whole idea of telehealth, ATA officials say, is to have the patient located at home or in some other, less expensive and less acute environment.

"Despite the laudatory statements, in the legislation and proposed rulemaking," the letter states, "the failure to waive these 5 specific Medicare requirements will effective prohibit the ACOs from coordinating care."

To learn more:
- check out the ATA's letter to CMS