Connect For Health Act Is A Telemedicine Bill That Has a Chance – Does the proposed bill finally have Telehealth In tune with CMS?
For years legislators have been trying to pass comprehensive telehealth policies with little success. Barriers on geography & cross state service offerings aside, the actual reimbursement pieces of almost all of the past proposed telehealth bills have been based on a dying model, fee for service (volume based). Although many state programs have enacted, fee for service type reimbursement regulation that requires insurance parity for consults and even CMS itself, though many would say limited, will reimburse for virtual visits on the per-visit premise, specifically in behavioral health. The truth though is that these type of reimbursement models are no longer Medicare’s mantra. It is now Value Based Care payment models. CMS is dedicated to creating reimbursement tracks that enforce providers to show & measure markers in the triple aim of healthcare. They want to see providers create positive outcomes in their patient’s conditions, cut costs in delivery of the care to them with measurable & documented success over time. They have vowed to tie provider’s bottom lines to it. This success will primary be achieved by leveraging telemedicine & telehealth tools but legislators have not yet presented policies for widespread approval to mirror CMS’s payment reform vision. But a new proposal on the table may be telehealth’s best chance to date to finally bring together policymakers and CMS in support of telehealth’s expansion.
The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act, is a bipartisan bill introduced by Senator Brian Schatz (D-Hawaii) along with six other senators from across the country. CONNECT would expand telehealth services through Medicare, ostensibly improving care outcomes, facilitating patients’ ability to connect with their doctors, and implementing cost-effective remote care solutions for patients and providers. U.S. Representatives Diane Black (R-Tenn.) and Peter Welch (D-Vt.) introduced companion legislation in the House of Representatives.
Why is CONNECT different from previous attempts at telemedicine legislation? Because for the first time, a bill uses language that ties telehealth application and usage to value-based care models, which is as mentioned, the models CMS is wanting to introduce. This bill uses phrases referencing the emphasis on cost containment, with the goals of CMS alternative payments models clearly stated in the bill with regards to value, resource utilization & clinical practice improvements in care coordination along with patient engagement. This value-based language appeases CMS leaders and policymakers who before may have opposed telehealth expansion due to its previous fee-for-service nature.
The proposed bill Creates a bridge program to help providers transition to the goals of the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) through using telehealth and Remote Patient Monitoring. Looking at previously released programs such as CMS’s Chronic Care Management (CCM) or CPT 99490 released at the beginning of last year, phrases like “non-phase to phase electronic communication” or “24 access to a patient’s care plans” are all in telehealth/telemedicine technology’s wheelhouse. Even the recent release of CMS’s Comprehensive Primary Care Plus (CPC+), the deputy commissioner of CMS, Dr. Patrick Conway, has been quoted saying “The CPC+ initiative is to support primary care doctors & other clinicians to spend time with patients outside of office visits, better coordinate with specialists which will result in healthier people & smarter spending of our healthcare dollars” The CONNECT for health act also allows telehealth and RPM to be not only used for qualifying participants in alternative payment models, but permits the use of remote patient monitoring for certain patients with chronic conditions. For example, Medicare beneficiaries with two or more chronic conditions & two or more recent hospital admissions would qualify the providers for reimbursement for placing them on a remote patient monitoring program. It also expands current classification limitations of originating sites, telestroke evaluation or management sites; Native American health service facilities; and dialysis facilities for home dialysis patients in certain cases, will now have the enhanced ability to qualify for telehealth reimbursement via CMS, with the CONNECT for Health Act. It also permits further telehealth and RPM in community health centers and rural health clinics and allows telehealth and RPM to be basic benefits in Medicare Advantage plans. As a direct reflection of the requirements in the bill regarding cost containment, quality measures, and data collection. The bill’s Avalere analysis of two of three of the major provisions showed $1.8 billion in savings over 10 years. The CONNECT for Health Act is supported by more than 100 organizations such as AARP,The American Telemedicine Association to name a few.
Current CMS reimbursement for telehealth services have been relatively restricted with the only steady growth or expansions seen in the state managed programs such as Medicaid. Where the national legislation has failed is restricting originating sites, geographic designation to only rural areas & the amount of covered medical specialties/providers.
Aligning Telemedicine’s proposed legislation to Value Based Care Models many organizations are already starting to attest to, is the rightful track telemedicine regulatory expansion must take. If telemedicine wants to become a healthcare delivery CMS or any payer will compensate providers for utilizing, it’s foundational policies need to meet these payer’s value based principles. An underlining notion of the possibility of the over utilization or even abuse of telemedicine tools in a fee-for-service based environment, even though they probably won’t admit it, is a Pandora’s box, in my opinion CMS doesn’t want opened, the telehealth policies tied to their alternative payment models proposed in the CONNECT for Health Act affords them some more control.
In closing, telemedicine & telehealth technologies are just tools. Now not only becoming viable but essential cogs in our broken healthcare system current reform. In the future as the value based care models mature, telehealth will be common avenues to deliver access to providers in the continuum of care. This is where our healthcare reform is poised to go, awarding incentive to the best providers who provide the best care & can show it definitively. Telehealth policy will continue to follow healthcare reform’s lead to achieve widespread adoption along with optimizing its revenue potential. The passing of the bill isn’t imminent as it was introduced in February & now has been referred to the senate finance committee who will set a future hearing. In an election year things can change but at this time The CONNECT for Health has a lot of momentum. Obtaining collective bipartisan support spanning across many legislative agendas & an enormous amount contributing telehealth workgroup usage data research from leading active telehealth programs around the country such as Mississippi (which we feature in issue2) bringing context to the proposed bill, it may be built to notch a national telemedicine policy win for us stakeholders. The drumroll that is telemedicine has been beating louder & louder. This group of policy makers may have begun to orchestrate the correct chord for telemedicine’s beat to become the bassline in the new song healthcare is now singing.
Question for the Telehealth Champions out there:
Do you agree tying value to telehealth reimbursement is our best bet for passing comprehensive telehealth legislation?
Comment below & Share if you agree !