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New Medicare Proposed Rule to Expand Telehealth Benefits

Posted by Lawrence Kerr on Thu, Nov 15, 2018 @ 06:00 AM

rawpixel-487102-unsplashMedicare is a crucial part of our healthcare system. Although some providers feel themselves unwilling or unable to accept Medicare, the reality is that 44 million people are beneficiaries. It impacts those people, as well as our healthcare system as a whole. This is important because the whole healthcare system tends to lean towards Medicare's policies.

So a new proposed rule affecting telehealth is practical, crucial, and fascinating to explore. 

Just recently, Medicare announced a new proposed rule for public comment and review that would greatly expand payment for telehealth. 

The full proposed rule change can be found here, but the general shift leans heavily on Medicare Advantage plans and is summarized as follows: "Under this proposal, MA plans would be permitted to offer – as part of the basic benefit package – additional telehealth benefits beyond what is currently allowable under the original Medicare telehealth benefit. In addition, we propose to continue authority for MA plans to offer supplemental benefits (that is, benefits not covered by original Medicare) via remote access technologies and/or telemonitoring for those services that do not meet the requirements for additional telehealth benefits."

The explanation and rationale for the shift includes this insight: "The healthcare industry has made significant advances in technology that enable secure, reliable, real-time, interactive communication and data transfer that were not possible in the past. Moreover, the use of telehealth as a care delivery option for MA enrollees may improve access and timeliness of needed care, increase convenience for patients, increase communication between providers and patients, enhance care coordination, improve quality, and reduce costs related to in-person care."

Not only is this a powerful positive development for medicare beneficiaries as well as healthcare providers who use telehealth -- we believe this represents an important philosophical shift. Telehealth is not an "an additional benefit" -- it's one of the many tools that healthcare providers have at their disposal to provide excellent care to all patients. This proposed rule is an important step away from that "special benefit" status of telehealth -- and towards it being just one more tool in our toolbox. 

Further, it is recognized that significant savings can come from the use of telehealth, as well as increased access by people who may be in rural, underserved, or hard-to-reach areas.  

The commonsense of telehealth seems to be slowly eroding the granite barrier of Medicare’s policy toward payment for telehealth.  As you know, there are significant restrictions about who, where and how a patient could benefit from technology applied to day-to-day care. Currently, live video conferencing from specific sites is the only reimbursable use of telehealth for Medicare recipients. We, of course, are strong believers in using technology to shift time as well as shift place. Hybrid Store-and-Forward Telemedicine®, for instance, uses asynchronous collaboration -- you respond on your own schedule -- so that both the patient and provider can solve problems without always using expensive hardware and having the interruption of scheduled appointments.

We understand CMS’s concerns about the potential for fraud and agree with the concerns. However, in our modern society with a fragmented health care system, collaborative and coordinated care has benefits that outweigh the risks.

For providers who care about good medicine and thoughtful healthcare, this new rule is an important development -- and likely shows the direction that reimbursement and medicine in general is headed. 

 

To learn more about Hybrid Store-and-Forward Telemedicine, including reimbursement issues, download our white paper: 

 ClickCare Quick Guide to Hybrid Store-and-Forward

Tags: hybrid store and forward medical collaboration, telemedicine reimbursement

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