The big news this month was the passage of the CHRONIC Care Act of 2017 which includes changes to Medicare and Telehealth reimbursement. This move was an important step because reimbursement limitations make institutions think twice about beginning a telemedicine program.
What it entails:
Dialysis patients (2019) – People with at-home dialysis will be able to have home monthly telehealth visits with their physician as long as in-person visits occur every three months. They can also receive the required equipment for telehealth without it being considered an inducement. Visits can be done remotely for questions or any issues that arise. The hope is that it will decrease the need for hospital or dialysis center visits.
Telestroke expansion (2019) – Previously telestroke services were only reimbursed in rural areas. This bill eliminates that restriction. Why? Because telestroke can lead to earlier diagnosis and treatment, the mainstay for better stroke outcomes.
Medicare Advantage Plans (2020) – These plans will have the ability to offer basic telemedicine services as a benefit.
ACOs (2020) – Certain ACOs can now reimburse for telemedicine services that are from home. It will also abolish the rural geographic requirements.
Overall, more Medicare beneficiaries will have access to telehealth services.
Why this is exciting:
Making telemedicine a reimbursable service could likely convince those who are on the fence because of payment limits to start rolling out their own programs. Payment limits are a legitimate deterrent and this is the first step to making telemedicine accessible to everyone. Medicare, of course, isn’t the only payor, but is a significant one. Hopefully this will convince other payors to follow suit.
This legislation recognizes the home as a place to provide care. The home is where most of a patient’s health care is actually practiced; telemedicine visits are beneficial because of that. The brick-and-mortar hospital model we have been so accustomed to is going to change and the home will be a safe place to diagnose and plan patient treatment for certain conditions. Will telestroke one day be able to expand the ‘other sites’ to the home making diagnosis even faster?
Abolishing the geographic restriction of telehealth is important as there are other regions where patients lack access to care including within cities. Limiting reimbursement to rural areas ignores the many people that can’t get to a clinic, find an appointment, or get specialist access. Everyone should be able to use telemedicine for quicker and better access to healthcare. This bill indirectly acknowledges that expansion of these services outside the limited scope of geography is necessary.
Why we can be optimistic about the future:
By slowly breaking down the barriers of how we reimburse telemedicine, where we consider an originating site of care, and where healthcare can take place will lead to dismantling the last vestiges of resistance to telemedicine. And this, hopefully, will lead to the tipping point of real forward change.