On December 30th, at the very end of the 112th Congress, Rep. Mike Thompson (D-Cali.) introduced a comprehensive bill to improve Medicare and Medicaid coverage of telehealth. This isn't new territory for Thompson; he introduced some major telehealth legislation as a California State Senator in the 1990s.
The latest bill's definition of "telehealth" covers various health services delivered remotely, including remote monitoring and videoconferencing, both for home care use, and to enable specialists to virtually practice at hospitals where they're needed.
Jonathan Linkous, chief executive officer of the American Telemedicine Association (ATA), told MobiHealthNews that when telehealth was in its infancy, legislators worried about abuse or that it wouldn't be cost-effective and they limited Medicare and Medicaid coverage to very particular cases -- only patients in rural areas could be reimbursed for any telehealth service that required patient-physician interaction, for instance. Thompson's bill, H.R. 6719, called The Telehealth Promotion Act of 2012, eliminates any such "arbitrary coverage restrictions," amending the Social Security Act to assert that telehealth must be covered in any case in which the corresponding in-person treatment would be covered.
Linkous said it's the right time for a change in telehealth policy, due to a combination of the technology itself improving and becoming cheaper, and the fact that telehealth is a more proven technology now. Threats of abuse or waste have not materialized, he said, even though some 10 million people are being served by telemedicine today.
Another big provision of the bill is that it would allow physicians to practice telemedicine across state lines without having to be licensed in both states, something which ATA estimates costs physicians about $300 million a year.
"For purposes of reimbursement, licensure, professional liability, and other purposes under this title with respect to the provision of telehealth services, physicians, practitioners, suppliers, and providers of such services are considered to be furnishing such services at their location and not at the originating site," the bill reads. In particular, Linkous cited the example of telehealth services for mental health, which can be done via mobile phone, and can currently create licensure problems if a patient wants to stay in touch with a therapist while traveling across multiple states.
The bill includes a positive incentive for hospitals to reduce readmissions, likely through the use of remote monitoring and home health. Previous legislation related to the Affordable Care Act had Medicare penalizing hospitals for failing to reduce readmissions. The provision in H.R. 6719 would, in addition, pass on some of the cost savings onto hospitals that were able to reduce readmissions more significantly.
It also includes a section that calls for Medicaid coverage for telehealth services in high-risk pregnancies. Linkous explained that in those cases it's usually not home-based, but rather a matter of using telehealth to bring a specialist for high-risk pregnancies into a care setting. High-risk pregnancies can be as complicated as they are time-sensitive.
"This is well-documented, straight-forward, not a lot of investment of time or money, and it really pays off," Linkous said. "So we wanted to get that one in there because it’s a clear winner."
The bill also launches some new pilot programs for remote patient monitoring and expands the "Medical Home" coordinated care option for Medicare.
Linkous said the timing of the bill wasn't accidental. Introducing it at the end of the session allows it to circulate through subcommittees for some time before being re-introduced to the 113th Congress, which began January 3rd. In the meantime, legislators can make changes and they can also insert pieces of the bill into other pieces of legislation as the year goes on.
"We expect it to be passed piecemeal," Linkous said. "With a comprehensive bill like this you have to expect to get things passed however you can pass them."
Linkous said telehealth is a fairly bipartisan issue, and he doesn't expect the bill to face fierce opposition. State medical boards will likely object to the changes in licensure rules, and some doctors might object on the grounds that telehealth amounts to added competition. But most of the challenge, he said, comes from government accountants who don't consider the full extent of savings created by preventative care.
"Say you have a stroke patient," he said. "You save their life, but you also save them from years of being in a nursing home, or home care. It’s billions of dollars saved if you can treat someone early on for a stroke. But the federal government accounting people don’t look at the cost of the nursing home, etc., they just look at the cost of the hospital stay, which might be the same. We have a very siloed approach toward accounting in the legislative process that doesn’t allow you to recognize billions of dollars in savings."