The 115th Congress (2017-2018) took big steps forward for telehealth.
First, members introduced 119 bills that included the term “telehealth” or “telemedicine,” a 42% increase over telehealth legislation introduced in the 114th Congress.
Second, the bipartisan Congressional Telehealth Caucus formed to “discuss how best to improve remote care to Americans who need it most.” Yes, you read that right: Bipartisan! There is enormous bipartisan support for telehealth in Congress.
Finally, nine bills related to telehealth became law. Two of the most notable contain important provisions expanding Medicare beneficiaries’ access to healthcare through telehealth services.
- The Bipartisan Budget Act of 2018 (BBA) expands Medicare coverage for telehealth treatment of acute stroke and end-stage renal disease (ESRD) by exempting them from the Medicare geographic restrictions and adding eligible facilities for the treatments (including the patient’s home in the case of ESRD!) effective January 1, 2019. It also will allow Medicare Advantage plans to expand their telehealth offerings and will allow the patient’s home as an eligible facility for telehealth services for certain Accountable Care Organizations, starting in 2020.
- The SUPPORT for Patients and Communities Act aims to address the opioid crisis by, among other things, expanding Medicare telehealth coverage for beneficiaries with substance use disorders or co-occurring mental health disorders. The law eliminates the Medicare telehealth geographic restrictions and adds the patient’s home as an eligible facility for these services starting in July. It also directs the DEA to activate a special registration for telemedicine prescribing of controlled substances by October.
CMS took some giant leaps forward.
The Centers for Medicare and Medicaid Services, in addition to implementing the above directives from Congress, took its own initiative to expand telehealth services, recognizing their value to patient-centered care, cost-effectiveness, and practicality.
First, CMS used its rule-making authority to get around the existing, statutory restrictions on Medicare telehealth services. It came up with three new, telehealth-like services that—because they’re not called “telehealth”—are not subject to the rurality or originating site restrictions. These services, called “Communication Technology Based Services,” took effect January 1 of this year and are aimed at avoiding unnecessary patient visits.
- “Virtual Check-Ins” allow a patient to call or video chat with a qualified provider to determine if they need to be seen—and the provider will be paid for this. I think this is something providers have been doing without being paid, so this is a new opportunity to be paid for services while saving time for both the provider and the patient and saving money for the system. There are restrictions, including patient consent, a small patient copay, and bundled payment if it results in an office visit or is related to a recent previous evaluation/management service.
- Even more interesting (because it’s asynchronous and CMS normally requires telehealth services to be interactive and real-time) is the new “Remote Evaluation of Prerecorded Patient Information.” For example, a patient could record a video of himself walking across the room so the provider can see the patient’s gait. The provider reviews the video or image, follows up with the patient within 24 hours, and gets paid for the service. Again it’s saving everybody time, it’s saving the system money, and it’s paying the provider for something they should be paid for. Restrictions apply.
- “Interprofessional Internet Consultation” allows a patient’s treating physician to talk to a specialist, with the goal of avoiding the patient having to see their primary care provider and then make a separate visit to a specialist when a remote consultation will be sufficient (and is certainly more efficient). Specialists, instead of donating their time as a professional courtesy, will now be paid for their service.
Another giant leap by CMS: You probably are aware that a year ago CMS took a baby step toward reimbursing for remote patient monitoring (RPM) by unbundling code 99091 (time spent collecting and interpreting RPM data). Now, as of January 1, CMS has added three new remote physiologic monitoring codes which to me seem to cover the gamut of RPM, even including setup and patient education on the use of RPM equipment. Note that RPM is not considered “telehealth” by CMS, so these services are not subject to the rurality requirement or facility restrictions.
In yet another pro-telehealth move, CMS has added two services to its list of covered Medicare telehealth services. These codes, G0513 and G0514, are for preventive services in an office or outpatient setting, and are subject to the rurality and facility restrictions.
And finally, CMS has embraced the BBA’s expansion of telehealth coverage for Medicare Advantage plans, allowing telehealth to replace certain in-person medical visits.
With all the recent Congressional and CMS activity aimed at expanding telehealth services, it seems we may have finally reached the tipping point for telehealth recognition and reimbursement. It will be exciting to see what happens in 2019!
Interested in finding out more about recent CMS changes? Tune into the ATP/SWTRC webinar, “A New Telehealth Reimbursement Paradigm in 2019,” by Jordana Bernard, MBA, of InTouch Health, tomorrow, Feb. 7, at noon MST.