Calling existing telemedicine payment regulations “arcane,” Department of Health and Human Services Chief Technology Officer Bruce Greenstein said the agency should review existing rules limiting Medicare reimbursement.
During an event hosted by StartUp Health at the J.P. Morgan Healthcare Conference in San Francisco, Greenstein told audience members they should expect “a lot of activity and some introspection” from the agency on existing policies, including a definition by the Health Resources and Services Administration (HRSA) that permits Medicare reimbursement in areas where there is a health professional shortage. The event was livestreamed on StartUp Health's Facebook page.
“There are a lot of rules that I think are arcane and they definitely deserve looking at,” Greenstein said, responding to an audience question lamenting the HRSA restrictions.
He added that there is “a lot of friction” between government regulations and virtual care innovations. But he also acknowledged that while the technology is readily available, the telemedicine industry is still searching for a dominant business model. He urged companies to continue working with state Medicaid programs to experiment with different approaches to reimbursement.
Greenstein also cautioned that when the Center for Medicare & Medicaid Services (CMS) has previously paid for off-site services, it has been accompanied by fraud, abuse, overbilling and upcoding.
“That’s something that I think would cripple telemedicine if the launch went too early and without a really good sense of making that business work tight,” he said.
Beyond telemedicine reimbursement, Greenstein stressed the importance of private sector collaboration. HHS is planning a series of 13 events in different cities across the country over the next two years. The first “Startup Day” is scheduled for Feb. 5 and includes senior administrators at the Food and Drug Administration and CMS, offering companies a chance to interact with government officials to help solve problems related to health data and analytics.
The events look to resolve a long-standing hesitancy from startups and private companies to collaborate with the government because it’s too slow or convoluted, Greenstein said.
HHS is also creating an opportunity for companies to undergo a parallel review by FDA and CMS and tap into a fund of money from investors seeking some assurance that new technology will be covered by CMS. Greenstein said the agency has already begun working with the American Society of Nephrology, FDA, CMS and the National Institutes of Health to create a “kidney innovation accelerator” focused on treating kidney disease.
“I want to compete with the private sector and get that innovation in HHS,” he said.