In contrast to last week’s deletion of telemedicine by the House Energy and Commerce committee from ’21st Century Cures’, this past Tuesday’s Senate Commerce subcommittee on Communications hearing was far more cheering for both telehealth and telemedicine advocates. More than twelve Senators spoke on behalf of telehealth expansion, especially Medicare reimbursement for telehealth in rural areas where there is limited care access. Holding this expansion back, according to iHealthBeat, are four factors: the limited cross-state licensing for physicians; the sluggishness of the Federal Communications Commission–despite initiatives such as Connect2HealthFCC [TTA 6 Mar 14], the FCC has blocked subsidies for nursing home broadband; reimbursement and limited broadband access in the same rural areas (more…)
Our readers, especially those in the US engaged with medical practices, might be interested in reading a two-part interview with Editor Donna by occasional TTA contributor Sarianne Gruber. We discuss the new model for Chronic Care Management (CCM) now included in what the Federal Government (CMS-Center for Medicare and Medicaid Services) pays physicians for Medicare patient visits and services. Telehealth, or in CMS terms remote monitoring, can play a vital role in the provision of care coordination, assessment, documentation, patient access and facilitation of self-management as part of the care plan, culminating in better outcomes at lower cost. Published in the new RCM (Revenue Cycle Management) Answers, a spinoff of HITECH Answers. Part 1. Part 2
Here’s some brief updates on US telemedicine legislation scene to hit the news recently.
Florida is progressing the telehealth bill we reported on 12 Feb 2015. The Florida Senate [grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/03/Florida-House-of-Representattives.jpg” thumb_width=”150″ /]Telehealth Policy Committee revised the draft bill on 18 Feb 2015 so the need for Medicaid reimbursements to be the same for telemedicine and face-to-face consultations is removed.
We have reported many telehealth initiatives from Mississippi and the state is now considered to be “a leader in telemedicine” according to a recent report in Politico. “Mississippi’s telemedicine program, ranked among the seven best in the country, has inspired neighboring Arkansas to take bigger steps in some areas of the field, and the impact of its success is making waves in Washington as well” continues Politico.
Mississippi is also helping to move telehealth at a federal level. Rep. Gregg Harper (R-Miss.) and Rep. Mike Thompson (D-CA) introduced a bipartisan bill in July last year to expand telehealth services under Medicare. The bill called Medicare [grow_thumb image=”http://telecareaware.com/wp-content/uploads/2015/03/mississippi-logo1.jpg” thumb_width=”150″ /]Telehealth Parity Act 2014 starts to move face to face and telehealth consultations to be on an equal footing.
[grow_thumb image=”http://telecareaware.com/wp-content/uploads/2014/10/file0001205588090-doctor.jpg” thumb_width=”150″ /]A bill has been introduced in the US Congress with the aim of improving Accountable Care Organizations (ACOs). The cross-party bill HR 5558, to be known as the ACO improvement act of 2014, if passed, will amend the Medicare ACO Programs to permit the use of remote patient monitoring, deliver images to remote providers and improve the data sharing between ACOs and Medicare administration.
ACOs are groups of doctors, hospitals and other health care providers who come together voluntarily to give care to Medicare patients. The goal of the three ACO programs is to ensure patients, specially the chronically ill, get the right care at the right time avoiding duplication and waste. When an ACO succeeds in achieving savings for Medicare, that saving is shared with the (more…)
When it comes to home health care, the C in CMS (Centers for Medicare and Medicaid Services) should perhaps stand for ‘contradiction’. According to recent reports appearing in the pre-holiday ‘dead zone’ of late last week, CMS has decreed that it must save, as part of a four-year plan under ACA, $58 million (0.3 percent) in fiscal 2015 (starting 1 Oct) from home health agencies which were formerly touted as a great way to save money. To put this in perspective: in 2013, Medicare paid about 12,000 home health agencies $18 billion to provide services to 3.5 million patients. In the US, Medicare has always had more restrictive rules for home and community-based services (HCBS); state-administered (but Federally subsidized) means-tested Medicaid still pays for the vast majority of long-term care (well over 60 percent, according to another Federal agency, Housing and Urban Development [HUD]), which strikes many observers as one pocket to another. So where are the contradictions?
- Conundrum #1: CMS has emphasized post-discharge, post-acute care as part of reducing acute care costs, exemplified in the penalty for 30-day same-cause readmissions. Nursing home expenditure is at least three times more costly than in-home LTC (a conservative estimate used by HUD).
- But CMS plans to cut Medicare home health funding in total so fewer people may receive it at all or less of it even if needed. What will be their alternative, and the effect on outcomes? (more…)
For those unfamiliar with the US Medicare programme, which provides healthcare benefits for over-65s, it is a tale of two halves. The first, or original, half provides funding for hospitals directly through Centers for Medicare and Medicaid Services (“CMS”). The second half of the tale is funding provided to insurance companies (known as Medicare Advantage Organisations or MAOs) to provide healthcare insurance cover. The details are complex and available on the official government site here.
Each year CMS sets the rates which the government will pay the MAOs and the proposed rates were published for consultation last month with the final decision being published next month. One of the respondents to the consultation was the Telecommunications Industry Association which strongly advised the CMS to support the use of telehealth within any MA plans as a means to reducing the cost of healthcare. While the TIA support is good news, and claims to be in the spirit of “long-time supporters of enhanced telehealth and remote monitoring services” I suspect the reasons are not entirely altruistic.
CMS says in its consultation document that some MAOs have asked CMS to include “remote access technology-furnished” services as part of MA plan basic benefits. However, as basic benefits can’t include anything not in the “original half” (Parts A &B) CMS proposes to continue to include these as “mandatory supplemental services” in the coming year.
In this context remote access technologies are defined as Telemonitoring, Web- and Phone-based Technologies, Nurse Hotlines and other similar services. For 2015, CMS is also to allow MAOs to furnish medical services to beneficiaries via real-time interactive audio and video technologies as a mandatory supplemental benefit.
Telehealth and telemedicine have reached a US milestone of sorts: the formation of a Washington, DC-based ‘advocacy’ (a/k/a lobbying) group constituted as a business non-profit. The Alliance for Connected Care is headed by three former Senators (two of whom were ‘amigos’) from both sides of the aisle and backed by a board including the expected (giants Verizon, WellPoint, CVS Caremark, Walgreens)–and the surprising (much smaller remote consult provider Teladoc and HealthSpot, the developer of the HealthSpot Station kiosk–hmmm, must be a fair chunk of their marketing budgets there) flanked by six well known ‘associate members’ including Cardinal Health and Care Innovations (another hmmm). There’s also a hefty ‘advisory board‘ including the American Heart Association and the NAHC (home care). The leadership team members are all members of major Washington law/lobbying firms. Tom Daschle is recognized as one of the most influential former Senators in town via DLA Piper, though himself not a registered lobbyist (OpenSecrets.org). Trent Lott and John Breaux hung out their own shingle and were recently bought by mega-lobbyist Patton Boggs. To put a fine point on it, more high-powered one does not get. The Eye sees that the time is prime for the Big Influence and…
What the Eye sees is Big Financial Stakes: Private insurers are required to cover telehealth in 20 states, as does Medicaid in most. The VA is a major user. But the great big trough of Medicare is new territory; covering 16 percent of the population, the use of telemedicine and telehealth is limited to certain geographic areas. (MedCityNews) This marks the infamous tipping point: the clarion call to ‘build significant and high-level support for Connected Care among leaders in Congress and the Administration’, ‘enable more telehealth to support new models of care’ and ‘establish a non-binding, standardized definition of Connected Care through federal level multi stakeholder-input process’ (whew!) Big companies want in, insurers want reimbursement, and they want it from somewhere as well. Toto, we’re not in the Kansas of Small anymore with ‘connected health’–we are now in the Oz of Big Money and Power Players. Alliance release (Oddly the website looks preliminary despite the big announcement and backing.)
More on this strategy: It’s called ‘soft lobbying’ and it is the latest thing in the Influence Wars. The Alliance for Connected Care is a 501(c)6 non-profit, similar to a business league like the Chamber of Commerce, and this has become a popular tactic. It’s also a less regulated, less transparent way to shape coverage, public opinion and exert influence on legislators. See this well-timed examination from the Washington Post on the corn syrup versus table sugar wars. ‘Soft lobbying’ war between sugar, corn syrup shows new tactics in Washington influence
According to a solicitation posted by the Department of Health and Human Services (HHS-Ed.) on Sept. 4, the CMS (Centers for Medicare and Medicaid Services) is commissioning the National Academy of Sciences (NAS) to study how best to add social and behavioral factors to electronic health record reporting. Washington Free Beacon
So a non-profit online publication, which one would site on the conservative or libertarian side (part of the Center for American Freedom), breaks a huge story, way ahead of the mainstream media, which has major implications for privacy, data security, public health, how goes your doctor or hospital visit and the level of care you receive. Is this EHR TMI (too much information)? The Federal inclusion is being linked to Stage 3 of the Meaningful Use program and reimbursement under Medicare, Medicaid and the Children’s Hospital Insurance Program (CHIP). The NAS already is working on this with the Institute of Medicine to draft suggestions for collecting this behavioral data and identifying “core social and behavioral domains to be included in all EHRs.”
With linking the data to outside
Nosey Parkers agencies such as public health entities, the possibilities for identified data becoming insecure or compromised increase dramatically. Will it be accessed (abused) by other entities involved in ACA such as the IRS, state Medicaid databases and Social Security? How much of this data will accidentially leak out in non-deidentified files? Will breaches of millions of non-encrypted records become the norm? Another important and oft-overlooked factor is the additional workload on already overworked hospital and clinical staff, who presently struggle to get comprehensive vital data correctly into multiple fields and screens on present EHRs–a major pain point among many speakers and participants at this past week’s iHT2 Health IT Summit. Finally, there’s the patient. He or she will be pressed to answer, due to penalties baked into the ARRA/HITECH MU3 incentives, the most personal questions about their life and behavior particularly if the diagnosis is one of what euphemistically was called a ‘social disease’. Having spoken this week to those in public health both at iHT2 and at Health 2.0 NYC, this Editor can see it as a deterrent to getting the care they need–or choosing evasion rather than truth with their doctor because there are no more confidences. Even the California Healthcare Foundation, hardly on the right wing, sounds an alarm in iHealthBeat.