Reprinted from MEDICARE ADVANTAGE NEWS, biweekly news and
business strategies about Medicare Advantage plans, product design, marketing,
enrollment, market expansions, CMS audits, and countless federal initiatives in
MA and Medicaid managed care.
May 25, 2017 Volume 23 Issue 10
At a time when congressional leaders are notoriously at odds over
health care reform, one piece of health care-related legislation that has
received bipartisan support is the Creating High-Quality Results and Outcomes
Necessary to Improve Chronic (CHRONIC) Care Act of 2017 (S. 870). The bill was
unanimously approved by the Senate Finance Committee on May 18 and includes
several new flexibilities for Medicare Advantage plan sponsors, including the
expanded use of telehealth that has been an underutilized benefit in Medicare.
Under current law, MA plans must cover the same telehealth
services that are available in Medicare fee-for-service. But reimbursement for
such services is contingent upon the patient’s physical presence at an approved
“originating site” (e.g., a physician’s office, hospital, rural health clinic),
and these sites are limited to facilities located in rural health professional
shortage areas, counties not included in a metropolitan statistical area or
those participating in a federal telehealth demonstration project. MA plans are
free to offer additional telehealth services but only as supplemental benefits
funded by rebates or premiums and not as part of their basic benefit package.
Because of these and other limitations, less than 1% of Medicare and Dept. of
Defense beneficiaries received care through telehealth between 2014 and 2016,
despite its potential to improve or maintain quality of care, reported the
Government Accountability Office.
Senate Bill Would Expand Telehealth
Originally introduced by the bipartisan Chronic Care Working Group
in December 2016, the CHRONIC Care Act was reintroduced this year without two
key provisions that were included in the 21st Century Cures Act, which became
law in December 2016 (MAN 12/15/16, p. 1). It includes, among other
things, four provisions that would expand telehealth coverage under Medicare:
(1) eliminating geographic restrictions on the use of telehealth for
individuals with stroke (a.k.a. “telestroke”), (2) expanding home remote patient
monitoring for those on dialysis therapy, (3) enhancing telehealth coverage for
accountable care organizations and (4) increasing flexibility for telehealth
offered by MA plans. Specifically, Section 304 of the act would allow an MA
plan to offer additional, clinically appropriate telehealth benefits in its
annual bid amount beyond the services that currently receive payment under Part
B beginning in 2020.
A preliminary cost estimate released May 16 from the Congressional
Budget Office (CBO) concluded that the bill would neither increase nor decrease
Medicare spending, and estimated that increasing convenience for MA enrollees
through telehealth would lead to a potential cost savings of $80 million
between 2018 and 2027. According to the American Telemedicine Association
(ATA), this is the first time that CBO has scored telemedicine legislation
since 2001, when legislation that is now part of the Social Security Act
“created longstanding barriers for Medicare telehealth coverage.” ATA is urging
its members to lobby lawmakers in support of S. 870 as well as the CONNECT for
Health Act of 2017; that bill, also reintroduced this year, has similar
provisions and would give providers more freedom to test telehealth.
Brodie Dychinco, general manager of convenient care for Cambia
Health Solutions, says he wasn’t surprised by the CBO’s estimate, given the
positive results his own company has observed in enabling these technologies
for its Regence health plans and other customers. Its telehealth solutions are
available primarily for commercially insured members, although they are offered
on a limited basis in its MA plan in Washington state. Dychinco says there was
some concern prior to rolling out the benefit about increased costs because of
the sudden availability of a “new convenience.” But when tracking whether
people who used telehealth were previously users of care, Cambia found that
four out of every five telehealth users “were essentially replacing what would
have been an in-person visit, meaning only one out of five [new visits] were
essentially generated from the telehealth space,” he tells AIS Health.
Moreover, the company found through survey data that patients were using
telehealth in place of emergency room, urgent care and physician office visits,
which resulted in the members saving roughly $80 to $120 on average per
telehealth visit.
The parent company also looked into whether people who actually
use telehealth end up going to the doctor anyway, but did not observe any such
duplication. “When we looked at the numbers, we looked at the diagnosis during
the telehealth visit, then looked at between one and six days after the visit
to see whether there was another in-person visit and if there was the same
diagnosis, and it was very small — under 2%,” he says. Cambia was one of 11
insurers that wrote the CBO last October requesting that “non-Medicare sources
of data” be used in its analysis of the cost savings impact of telemedicine in
Medicare (MAN 11/3/16, p. 8).
MAOs Welcome Opportunity to Improve Access
MVP Health Care, which signed the CBO letter, is also in support
of the legislation. The insurer this year launched a telemedicine benefit
allowing members in its fully insured plans that include Medicare and Medicaid
to access a variety of health care professionals, including behavioral health
specialists, via a mobile device or computer and webcam.
“MVP Health Care is out in front of the industry by offering
direct-to-consumer telemedicine via our MyVisitNow 24/7 online doctor visits to
our Medicare Advantage members,” states Cupid Gascon, M.D., vice president of
clinical transformation for MVP. “We know our members always benefit from
having more ways to access necessary care, which is especially true for our
Medicare members who often experience barriers to access attributable to
impaired mobility or limited access to transportation. Any legislation that
increases access to programs such as this would be beneficial to our
communities, but MVP is already committed to providing our members with the
best care and greatest access possible.”
Meanwhile, Independence Blue Cross last year launched a
telemedicine option with vendor MDLIVE enabling its commercial membership to
connect with a network provider when needed. The plan is encouraged by the
“exciting” prospect of being able to expand such services for seniors,
according to Heidi Syropoulos, M.D., medical director for government markets
with the Philadelphia-based insurer. “Since the ‘originating site’ for the
member has to be rural, we just don’t have anybody that’s really qualified for
that and as it is now, our MA plans offer essentially what [FFS] Medicare
does,” explains Syropolous.
One potential use of telehealth in MA, suggests Syropoulos, could
be having nurse practitioners visit a patient’s home within a week
post-discharge and enabling a video conference with the patient’s primary care
physician to conduct a home assessment and medication reconciliation, “which we
feel and hope will decrease the likelihood that a member goes back to the
hospital. And transitions of care between the Skilled Nursing Facility and the
home or the Acute Care Hospital and the SNF and the home are really fraught
with all kinds of problems, so expanding telehealth to the point where we’d
have our eyes and ears in the home is a potential that would be really
fabulous.”
View a summary of the legislation at http://tinyurl.com/kehlsml.
https://aishealth.com/archive/nman052517-01?utm_source=Real%20Magnet&utm_medium=email&utm_campaign=113103869
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