MedPAC Discusses Policy Principles for Potential Expansion of Telehealth in Medicare
March 8, 2016 10:35 AM
On March 3, 2016, the Medicare Payment Advisory Commission (MedPAC) convened a session entitled, “Telehealth Services and the Medicare Program.” During the session, the Commissioners discussed the current utilization and efficacy of telehealth services, as well as policy principles to guide the potential expansion of telealth coverage under Medicare. MedPAC previously met to discuss this topic in November 2015; MedPAC has updated its research determining that “evidence of the efficacy of telehealth is mixed.” Its June 2016 report will contain a chapter with policy principles pertaining to telehealth, rather than official recommendations. However, several Commissions urged that MedPAC was being overly cautious in its approach.
The session began with MedPAC staff providing an overview of telehealth utilization and efficacy. They described telehealth as a multidimensional set of services, with Medicare’s coverage of telehealth under the Physician Fee Schedule limited to rural locations and specific services. MedPAC concluded that the use of telehealth was very low within Medicare but that it has been growing recently. MedPAC described that some employers and insurers were using telehealth outside of Medicare, and that the Department of Veterans Affairs uses telehealth more widely. Finally, MedPAC concluded that the ability of telealth to expand access, improve quality and reduce cost was mixed.
MedPAC staff provided examples of potential policy principles to guide the expansion of telehealth in Medicare for the purposes of discussion during the session. Such potential policy principles included: in the context of fee for service expanding coverage to services that provide access to timely care with a low potential for unnecessary use (e.g. tele-stroke) and allowing primary care providers to offer more telehealth services under PMPM partial capitation model; in the context of bundled payment models and ACOs, expanding coverage of telehealth if providers are at risk for total spending for episode or population; and in the context of Medicare Advantage, expanding to allow plans to include supplemental telehealth services in their bids.
Commissioner Craig Samittexpressed concerns that CMS and MedPAC were both moving “too cautiously” toward fostering telehealth adoption. He said that telehealth can suppress cost drivers in the health care system, such as inpatient admissions, which in turn ensures that the benefit of telehealth coverage strongly outweighs the incremental cost of service coverage expansion.
Echoing those concerns was Commissioner Scott Armstrong. “I worry that we are being far too conservative. Even the tone of this conversation is far more cautious about this,” Mr. Armstrong said. “I think the technology and patient expectations are moving far faster than our payment policy is right now.”
Additional information about the MedPAC presentation is available here.