Can the Mayo Clinic convince Congress to take telemedicine seriously?
That's the gist of a July 4 story in the Minneapolis Star-Tribune, which notes how the Rochester, Minn.-based health system is absorbing the cost of its eICU service to seven network hospitals and charging a subscription fee for telestroke consults to health systems outside the Mayo network. The pioneering health system, which saw a 36 percent boost in income from operations in 2014, to more than $834 million, can foot the bill for now, but its goal is to spur Washington to enact legislation that compels Medicare to cover more of the costs.
“Medicare reimbursement for telehealth is kind of stuck in the 1990s,” Randy Schubring, the Mayo Clinic's public policy manager, told the Star-Tribune. And that wasn't a good decade for healthcare.
While some 27 states have enacted legislation requiring private health plans to cover telemedicine visits, Medicare is the leader of the pack, and Congress isn't in any hurry to compel the Centers for Medicare and Medicaid Services to change its tune. CMS did recognize the value of telemedicine in chronic care treatment this past year when it agreed to reimburse for some telehealth services – a move hailed by the American Telemedicine Association, among others – but it's s drop in the bucket compared to what could be done.
“It takes a longer vision than what some people in the healthcare community have,” Daniel Brown, May's chief of critical care and head of its eICU program, told the Star-Tribune. “It’s kind of shortsighted what’s happening now.”
California Congressman Mike Thompson is expected to resubmit his Medicare Health Parity Act this week. The bill, which was filed last year but went nowhere, proposes to reimburse remote programs for people with chronic diseases, as well as telemedicine programs run by federally qualified health centers. Also in the works is the "21st Century Cares Act," a mammoth bill expected to help shape healthcare policies for the foreseeable future, which faces a full House vote this week before moving on to the Senate, where it faces strong debate.
While the 21st Century Cares Act does call on CMS to study telemedicine reimbursement options, the directives are open-ended, meaning no one faces any deadline to make a decision. That has prompted ATA CEO Jonathan Linkous to warn that any meaningful improvements in telemedicine reimbursement could take years.
This makes the Mayo program more meaningful. The organization, which began subsidizing its eICU two years ago, now covers about 100 beds in network hospitals in Minnesota, Wisconsin and Georgia. It serves as a model for many other healthcare organizations, with systems from as far away as the Middle East inquiring about partnerships.
As the Star-Tribune reports, the May Clinic eICU is a prime example of the vision of connected care that powers healthcare transformation, but that vision is clouded by reimbursement barriers. "(T)o Mayo and other healthcare innovators across the country, telemedicine will play an increasingly major role in the future of effective and affordable healthcare," the article states. "They think federal policies which recognize that fact make more sense than forcing care providers to overcome licensing restrictions as well as payment restrictions as they remotely treat ICU patients, remotely diagnose strokes, remotely direct the delivery of babies and remotely monitor patients in real time in their homes."
“To those of us involved in telemedicine, it is inevitable that we will practice this way,” Steve Ommen, the Mayo Clinic's director of connected care, said.
If only Congress would agree.