Speakers: Johnathan Linkous & Gary Capistrant of American Telemedicine Association.
This month in Telemedicine is hosted at the end of each month by the American Telemedicine Association (ATA) and is free to the public. Archived videocasts are available on their website. I highly recommend checking out their wiki website where you will find information on legislative state issues to general definitions.
62.5 million individuals were on Medicaid last year with a spending of $505 billion in 2013. These high numbers reflect the importance of legislative involvement to determine payment rates for Medicaid healthcare services. For those of us that do not know, Sustainable Growth Rate (SGR) is a system that was put in place in 1997 by the Centers for Medicare and Medicaid (CMS) to control Medicaid spending. Telehealth makes it possible for health services not to end with the clinical visit. However, the system is over 20 years old and pressure is being put on congress to come up with solutions that are in line with the need to move from fee for service to more innovative service models to support new solutions.
With the March deadline of Medicare physician fee payment schedule fast approaching, there is understandably a lot of federal activity. Medicare cuts are again being delayed because the budget estimates on cost of repeal have gone up and there is much difficulty coming up with a way to offset savings. It’s a case of poor budge planning, again. With that said Congress will be applying a ‘patch’ instead of a fix, a common ritual that has been occurring for 15 years. Last year they applied the SGR Repeal and Medicare Provider Payment Modernization Act of 2014 bill as a ‘patch’. It is important to ATA because part of the SGR package is to put in place payment reforms, pressure to move reimbursement from fee for service to various payment innovations and because one provision in particular is set to waive Medicare restrictions for alternative payment methods (APMs). The big deal is this and there is no way around it: “Congress has to act by the end of March in order to avoid Medicare docs from taking a one quarter cut in payment rates.”
The Energy and Commerce Committee, an unlikely participant in the healthcare realm, developed the 21st Century Cures Act launched last April and is considered by Mr. Capistrant the “best single effort by any congressional committee ever on telehealth.” This is exemplified in the many committees on goings, the most resent being their efforts to open up discussions on Children’s chronic health Issues and how telehealth can network healthcare system entities (i.e. The nations Children’s Hospitals, etc.). Mr. Capistrant believes much of the committee push and interest in telehealth are in place because the chairman, that has spearheaded the momentum in congress to build better payment innovations and remote monitoring, will be leaving after this congress.
On a state level there have been over 100 telemedicine bills introduced, 15 states have introduced Provider standards in dealing with telehealth. However there are still eight states that do not provide some form of Mediciad telehealth reimbursement. Regarding State Licensing compacts, the question still looms: to require state by state licensure or move to the nurse’s model of reciprocity? Stay tuned.