As requested by Congress as part of an appropriations bill signed into law late last year, this month, the Department of Health and Human Services (HHS)released a report highlighting its e-health and telemedicine efforts. The report makes for interesting reading, and while there are no significant surprises in the report, it offers a clear snapshot of some of the agency’s thinking regarding virtual care.
The first thing I noted in the report is the agency’s view that “telehealth holds promise as a means of increasing access to care and improving health outcomes.” This is important because it has not always been clear whether the agency views telehealth quite in the same favorable way as other stakeholders increasingly do. The other thing I noted was the agency’s view that the various alternative payment methods currently being tested may facilitate expansion of telehealth.
Among other things, the report details some of the policy challenges faced by telehealth stakeholders:
- Significant variability in telehealth coverage from one payer to another.
- State licensure requirements for clinicians and the administrative burden such requirements impose on clinicians.
- Credentialing and privileging.
- Gaps in access to affordable broadband.
HHS indicates that many reforms are currently being tested or implemented to address these challenges. For example, in the area of reimbursement, the agency notes that it is currently testing more expansive telehealth coverage through its Next Generation ACO Demonstration, and highlights MACRA’s incentives for physicians to use telehealth. The report references the agency’s new rule that permits the use of telehealth modalities to provide Medicaid home health services.
The report also provides an overview of telehealth-related federal activity including:
- The number of telehealth grants administered by HRSA and SAMHSA.
- The establishment of the Federal Telemedicine Working Group (comprised of 26 agencies and departments such as USDA and the FCC) to facilitate telehealth education and information sharing.
- ONC developing an inventory of federal telehealth activities.
- AHRQ providing an evidence map of the available research regarding telehealth.
- The continued great telehealth work being done within the VA and reasons why that model may not be scalable.
Overall, the report is an illuminating but relatively unsurprising take on agency thinking. In particular, two nuggets stood out. First, the agency appears to view chronic disease management as a particularly good fit for telehealth. In recounting that almost half of all adults have at least one chronic illness and that chronic disease accounts for 75 percent of all health expenditures, the report concludes that telehealth “appears to hold particular promise for chronic disease management.” It goes to reason that any expansion of telehealth under Medicare will probably first focus on chronic disease management. Second, HHS signaled the importance of Medicare Advantage in any telehealth expansion effort, by including a proposal in the President’s budget request for FY 2017 to expand the ability of MA organizations to provide telehealth by eliminating otherwise applicable Part B requirements that certain services be provided only in-person.