Tele-stroke, tele-ICU could qualify for reimbursement under CMS rule


Tele-stroke, tele-ICU and a few other established telehealth services may finally get Medicare reimbursement, according to a proposed rule on the Medicare physician fee schedule released Friday.

In the proposal, CMS officials say telehealth services can qualify for payment even if they're not the direct, one-to-one equivalent of an in-office visit. Instead, telehealth services would only have to provide a "clinical benefit," the proposed rule states.

Under the existing standard, a telehealth visit had to provide all the same exam, measurement and other capabilities of an in-person visit -- a high bar to meet, Jonathan Linkous, CEO of the American Telemedicine Association tells FierceMobileHealthcare. The change is crucial because it means telehealth visits that are valuable, but may lack one or more of the capabilities provided with a face-to-face encounter, can still qualify for payment. (Note: CMS hasn't defined, or even qualified, where it will set the bar for "clinical benefit.")

The services won't make the list until 2012, Linkous adds. ATA and other industry groups will have to submit a list of proposed additions later this year, and they'll have to be added as changes to the 2012 physician fee schedule.

First on the list: Tele-stroke and tele-ICU programs. These well-tested telehealth services have been on ATA's reimbursement wishlist for years, and may finally qualify under the "clinical benefit" standard, Linkous says.

Other telehealth tidbits in the proposed rule:

-- Smoking cessation programs: Under the proposal, Medicare would pay for telehealth-enabled progams to help patients quit smoking.

-- Care coordination: The proposal specifies that care coordination services can be provided telephonically, or electronically, Linkous notes. That may open the door to remote patient monitoring systems that can provide important information -- medication adherence data, vital sign monitoring, etc. -- for coordinating a patient's care. "We think this may indicate this is paving the way for remote patient montioring in telehealth. In some of this [proposal], you have to read between the lines," he says.

To learn more:

- read the CMS summary

Related stories:
Telehealth experts push CMS for more flexibility 
ATA: CMS must loosen telehealth rules, allow wider use of ACOs