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Virtual Care Advancement | Outlook on CHRONIC Care Act and Other Federal Legislation

The Senate’s unanimous passage of the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 (S.870) on September 26th is an encouraging step forward for modernizing telehealth access and reimbursement. The bipartisan, budget-neutral bill aims to improve health outcomes for Medicare beneficiaries living with chronic conditions and includes key provisions expanding access to telehealth. A summary of the key telehealth provisions under the CHRONIC Care Act can be found here.

The bill now moves to the House Subcommittee on Health and may be adopted in its current form or integrated into existing House bills. The House has already advanced three separate bills this year with telehealth provisions similar to those included in the CHRONIC Care Act: expanding telehealth services under Medicare Advantage (HR 3727), expanding telehealth for stroke patients (HR 1148), and expanding the use of telehealth to facilitate the use of home dialysis (HR 3178). With seemingly aligned goals between the two chambers, the House may accept the remaining provisions of the CHRONIC Care Act, or negotiate minor changes and incorporate the CHRONIC Care Act into another priority health care related bill, such as extending federal funding for the Children’s Health Insurance Program, as a vehicle for passage this calendar year.

The recent momentum of federal legislation focused on expanding telehealth services to Medicare beneficiaries signals Congress’ continued consideration of telehealth’s ability to improve patient health and lower the costs of health care delivery. In light of this increased legislative activity, health care providers, commercial payers and telehealth technology companies should be mindful of the following.

  • Consider developing or participating in studies designed to test the efficacy and efficiency (including costs) of telemedicine programs.
  • Continue exploring ways to tailor their care delivery and revenue models to provide telehealth services to Medicare beneficiaries.
  • Offer Center for Medicare and Medicaid Services (CMS) and MedPAC insights and guidance on ways to provide the Federal government agencies overseeing Medicare coverage and payment for telehealth services the best available industry information.
  • Focus operational goals to achieve cost and value goals that are of concern to the government.



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The Way Forward for Telemedicine

A lot of us have argued that one of the floodgates for telemedicine has been reimbursement. If states and the Federal government more liberally reimbursed or required reimbursement for telemedicine service, we argue then a significant barrier to broader telemedicine will be removed. This is a valid argument, and the potential flurry of activity on Capitol Hill as of this writing (September 20, 2017) gives many hope that Medicare reimbursement for telemedicine may be greatly expanded soon.

Alas, another problem persists. A spate of recent surveys and reports on utilization demonstrate that awareness should be viewed as a similar sort of barrier. It is, of course, a generalization to say this, but consumers are largely unaware of the benefit being made available to them, or are unaware of the appropriate uses of a telemedicine service. It would be foolish to speculate as to the reasons why, but a recent trend may help to erode this barrier.

When it comes to customer service and user engagement, none are better than our technology industry. The West Coast tech giants clearly understand how to engage and attract users. The remarkable success of smart phones provides ample evidence—can you think of any other consumer product of comparably high-cost being as ubiquitous? It is also clear that the health care industry has failed to engage consumers as effectively. There are likely multiple reasons for this. Health care is: (1) highly regulated, resulting in limited ability to be quickly responsive to consumer demands; (2) run by professionals trained in many things, but not sales or consumer satisfaction and engagement; and (3) burdened both by a lack of competition at the point of sale, and by a third-party payment system that has so far proven to be impervious to the forces of disintermediation. (more…)




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