A band of industry, trade groups and accountable care organizations
has sent a coordinated series of three letters to new HHS Secretary Sylvia Mathews Burwell
pushing potential changes to the ACO program to better accommodate telehealth
and remote patient monitoring.
That aspect of the connected health sector has been frustrated by a patchwork of regulations and reimbursement policies hindering adoption, the groups contend.
The three letters focus on several existing telehealth policies,, which create disincentives for using telehealth. Together, they mean that “those of us working with providers who do not receive reimbursement for connected care services are faced with the difficult decision of assuming financial risk by providing the care for free. For many physician-led and smaller ACOs without access to a lot of capital, it is not even an option.”
The groups are particularly frustrated by rules barring reimbursement for “originating sites” outside of rural areas; rules barring “store-and-forward” policies that prevent data from being forwarded to outside services; and a lack of coverage for services in the home or other common medical locations.
But Burwell has it within her power to waive those restrictions, and the signers are hoping, according to the letters, that the agency opens a request for comment in the Medicare Shared Savings notice of proposed rulemaking.
Signers include tech heavyweights Qualcomm, Intel, Panasonic, trade associations such as the Telecommunications Industry Association, the American Telemedicine Association, the Alliance for Connected Care, and provider and ACO groups including Geisinger, Banner Health and Lancaster General Health.
Encouraging connected care can reduce costs by facilitating coordination of care, and moving care into lower-cost settings – from a hospital to a doctor's office; or preventing emergency care visits, they argue. Telehealth also can reach patients who might not have access to doctors otherwise, they contend.
Krista Drobac, the executive director of the Alliance for Connected Care, said in an interview that her group had heard that an ACO rule was about to come out, and the intent was to communicate their ideas.
It's supplemented its efforts to lobby government agencies and Congress by funding research to bolster its case; the group has given partial support to a group of academics, which will result in soon-to-be-published research on the benefits of connected health. The literature review specifically shows strong results for telemonitoring for congestive heart failure and telestroke, though more neutral results for COPD.
If regulators don't react, Drobac says her group's backup plan is primarily legislative, noting with favor efforts to put payment reform into SGR reform. Brian Scarpelli, the director of legislative and government affairs at the Telecommunications Industry Association, said his group will explore other regulatory paths, such as meaningful use
stage 3. Follow Darius Tahir on Twitter: @dariustahir