Telehealth laws inhibit widespread use in Medicare population, CMS says
- Restrictions on where Medicare patients can receive telehealth services are limiting use of the technology, CMS said in a report last week to Congress.
- Under the 21st Century Cures Act, CMS is required to report to Congress on Medicare beneficiaries' telehealth use. In 2016, nearly 90,000 Medicare fee-for-service beneficiaries used slightly more than 275,000 telehealth services — just 0.25% of the 35 million FFS Medicare enrollees analyzed for the report.
- The lack of usage is due, in large part, to current Medicare law, which requires that patients be in an originating site when telehealth services are furnished. Such sites must be in a rural health professional shortage area or a county outside a metropolitan statistical area or that is participating in a federal telemedicine demonstration project.
Current laws and regulations also prevent Medicare enrollees and dual eligible from accessing telehealth services in their homes. That and the restrictions limiting originating sites to rural areas are "the greatest barrier preventing the expansion of Medicare telehealth services," according to the report.
The analysis shows that the greatest growth in telehealth usage is among beneficiaries 85 years and older. More than 85% of those using telehealth had at least one mental health diagnosis, and psychotherapy was among the most frequently delivered telehealth services. The 10 states with the highest telehealth utilization are Texas, Iowa, California, Missouri, Michigan, Minnesota, Wisconsin, Georgia, Virginia and Kentucky.
CMS notes the low rate of telehealth use — one quarter of 1% — may be understated, since Medicare claims data don't capture some other technology-based services such as remote cardiac monitoring. Still, use is low.
According to the report, switching just 1% of Medicare's in-person visits to telehealth would result in a 13-fold increase in telehealth usage within the program.
The chief uses of Medicare telehealth services are office and outpatient visits, psychotherapy, emergency department consultations and follow-up with patients in nursing facilities. Two other areas that are showing marked growth are medication consultations and neurobehavioral status exams.
The analysis identified 19 other high-volume services suitable for telehealth delivery, including therapeutic activities to improve function, care provided to critically ill or injured patients in the first 30 to 74 minutes and hospital discharge day management.
Broader use of telehealth services by Medicare enrollees could be a catalyst for wider adoption in the general population, as is often the case with new treatments and technologies. Many of the steps CMS is taking to open up telehealth options seem to focus on alternative payment models.
Under its bundled payments initiative, CMS waived geographic requirements for telehealth services provided to eligible enrollees during a Model 2 (acute care inpatient stay plus post-acute care up to 90 days post-discharge) or Model 3 (post-acute care services with skilled nursing, rehabilitation, long-term care or home health agency) episode. The agency also provides waivers for telehealth use under the Comprehensive Care for Joint Replacements model.
During last week's Alliance for Connected Care Telehealth Policy Forum for Health Systems, CMS Administrator Seema Verma described plans for a digital health network where widespread use of wearable devices, coupled with enhanced patient-provider information flow, improve care quality and outcomes.
Health IT Now, a broad-based coalition of provider organizations, payers, employers and patients, said the report supports the need for legislation expanding reimbursement for telehealth services. Specifically, the Reducing Unnecessary Senior Hospitalizations (RUSH) Act (H.R. 6502) would allow Medicare to form value-based arrangements with medical groups to provide acute care at skilled nursing facilities using a mixture of telehealth and on-site care.
"In this report, CMS makes the case for passage of the bipartisan, Health IT Now-endorsed RUSH Act better than we could ourselves," Joel White, the group's executive director, said in a statement. "Now, the agency should put its findings into action by joining us in calling for swift passage of this sorely needed legislation during the current 'lame duck' session."