An encouraging prediction? Two Foley & Lardner attorneys with evidently a great interest in healthcare predict that 2016 may very well be The Year of Telehealth. Why? They cite accountable care organizations (ACOs) and the coordinated care at the heart of their model as a protected activity under the Medicare fraud and abuse waivers. “Coordinating care, such as through the use of telehealth, remote patient monitoring, and other enabling technologies”is “an activity reasonably related to the purposes of the Medicare Shared Savings Program and therefore is eligible for protection under one or more of the fraud and abuse waivers”. National Law Review, mHealth News. While from the legal point of view this may be significant, there’s been a concatenation of other factors.
What are the drivers for telemedicine and telehealth in ACOs? In the Medicare Shared Savings Program (MSSP), which is one model, ACOs must leverage savings, and perhaps the largest is avoiding unnecessary hospitalization costs among ‘high-risk’ patients–those with chronic disease–and usually more than one. They are also over half of high ER/ED utilizers. The Federal agency behind Medicare, the Centers for Medicare and Medicaid Services (CMS) has since 2011 been signing up ACOs in risk and value-based payment models that offer incentives such as shared savings. In 2014, only 28 percent of ACOs in the MSSP program earned shared savings bonuses. In the last few months, CMS has upped the ante in driving for alternative payment models to replace traditional fee-for-service Medicare. They have ambitious goals to move 30 percent of payments by 2016 and 50 percent by 2018 to value-based.Other ‘go’ signs are that Medicare 2015 reimbursement rules on chronic care management include telehealth in non-face-to-face care, and that telehealth was included in last June’s final rule on health IT in care coordination (iHealthBeat).
Telehealth and telemedicine are proven ways to monitor those with chronic diseases and keep them out of hospitals and ER stays–yet according to a 2015 survey conducted by the eHealth Initiative and Premier, only 20 percent of ACOs are using one or both.
Will it be the year that telehealth finally finds its way into care coordination–and gets paid for it? This Editor has been hearing the same song since 2006, but ten years later, there’s more likelihood. The acquisition of telepsychiatry provider 1DocWay‘ by specialty pharmacy operator Genoa earlier this week, and the sudden value placed on telemedicine (a rich initial valuation given to Teladoc when going public) also help. 2017 anyone?
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