By Sarianne Gruber
On October 31, 2014, the Centers for Medicare and Medicaid Services (CMS) released the Final Rule for the 2015 Physician Fee Schedule, the annual 1,100 page list of what the Federal Government pays physicians for Medicare patient visits and services. Let’s continue our discussion on these changes and what they may mean for clinicians interested in using telehealth and digital health technology in their day-to-day practice. And thank you, Donna, for providing us with comprehensive and applicable information on the submitted questions.
Do you think providers will be more apt to use telehealth care for their patients now that it can be included in a Medicare CCM reimbursement framework?
Certainly it has raised physician, practice and ACO awareness of the role telehealth monitoring can play in overall care management. Telehealth companies are actively taking up this opportunity to work with providers. Providers of care management, practice management and billing systems have been fielding many questions on how they interface and enable CCM functionality. There are also many revenue projections, and for practices with many qualifying patients, the potential for added revenue is considerable. But the support requirements are also, as I noted previously, extensive and rigorous. CMS has not put out any Fact Sheets on CCM that I can locate, but some companies that market practice care management systems have.
Has CMS recognized any other services delivered by telehealth?
CMS also uses telehealth to refer to telecommunications systems that substitute for ‘in-person encounters’ which is the generally understood definition of telemedicine! In this context, CMS switches meanings to virtual, same time video or audio doctor-patient visits.
The Final Rule expanded the existing Category 1 (similar to current approved services) by seven codes to include: annual wellness visits (HCPCS codes G0438 and G0439), prolonged E&M services requiring direct patient contact (CPT 99354 and 99355), psychoanalysis (90845), and family psychotherapy with (90846) and without (90847) the patient present. As with previous telehealth services, the reimbursement is geographically limited to originating sites located in rural health professional shortage areas (HPSAs) and in counties not included in metropolitan statistical areas (MSAs). The CMS Fact Sheet on this is helpful in reviewing all eligible services, geographic limitations and requirements, and written in user-friendly language.
Do you think reimbursement will eventually cover non-CCM services?
My hope, shared with so many others, is that the example set by CMS and also organizations like the VA which use multiple digital health tools such as telemedicine, store-and-forward imaging and home telehealth, will positively influence private insurers and companies to adopt digital health services coverage in their plans for members and employees struggling to manage chronic conditions. They’ve invested millions in wellness incentive programs that mostly help the already well or those who should be concerned. These programs reportedly work to better some health indicators and reduce absenteeism by encouraging positive lifestyle factors, but they largely don’t help those who need extra assistance in self-management and have real, ongoing diseases.
We may be reaching a tipping point—finally– this year and next in greater plan inclusion of telemedicine and virtual consults. This is straightforward and telemedicine companies such as American Well, Teladoc and Doctor on Demand are well established—the barriers are mostly state regulations. This also applies to behavioral telemedicine which can be extraordinarily helpful in treatment plans for those with mental health needs.
The case for home-based Telehealth support is also evident. The results that the VA has had for over a decade confirm that care is improved with remote physiologic monitoring and patient education, as well as money saved. In FY2014, according to their reports and releases, the VA used home telehealth to reduce bed days by 42 percent and hospital admissions by 34 percent. They calculated they saved $1,999 per patient per year in the prior year. Veteran patients are happy with Telehealth services in VA care, with an 85 percent patient satisfaction rate. It keeps veterans in their homes and communities. Yes, the VA is a closed system. There are nearly 20 years of other studies that directionally confirm both outcomes and savings. Insurers and large companies need to realize that telehealth is no longer tied to landlines and boxy hubs—it’s gone mobile on tablets and smartphones, the devices use Bluetooth LE as well as USBs. Telehealth fits now much better into active patients’ lives and lifestyles, and used right, encourages self-awareness and self-management. I believe it’s time to move forward in program implementation and paying for Telehealth – pilot first with tightly targeted populations, adjust and roll out these programs to improve population health.
About Donna Cusano
Donna Cusano is a strategic marketer, consultant and writer/editor who has been part of the world of digital health and healthcare since 2006. As a marketer, she has headed marketing and provided independent advisory services on marketing and communications strategy + programs for several early-stage companies pioneering in telehealth and telecare (behavioral/activity monitoring for care). Since 2009, Donna has also observed digital health developments and the healtherati from an editorial perspective, as New York-based Editor in Chief of Telehealth & Telecare Aware, the only internationally-focused independent professional review of healthcare technology news and issues. LinkedIn profile