ATA: CMS must lift telemedicine restrictions for ACOs
The American Telemedicine Association (ATA) lauds the federal vision for accountable care organizations (ACOs) and the inclusion of modern technologies and telehealth, wrote Jonathan Linkous, ATA CEO, in a letter to Donald M. Berwick, MD, administrator for the Centers for Medicare & Medicaid Services.
However, the Washington, D.C.-based group also called on federal agencies to lift “Medicare’s outdated restrictions” on telemedicine. “The proposed ACO regulations [will] still be subject to formidable statutory restrictions for telehealth services under Medicare Parts A and B as authorized under Social Security Act section 1834(m),” the letter stated.
Congress gives the Secretary of the Department of Health and Human Services the authority to waive this restriction under section 1899(f), “but unfortunately this was not included in the proposed rulemaking. ATA strongly urges the Secretary to waive this restriction. Otherwise, the ACOs will fail to fulfill Congressional and Agency intent,” the ATA stated.
Telehealth should be an integral part of ACOs, the group said. The benefits of telehealth for the Medicare program include reduction of overuse of emergency room visits and preventable inpatient admissions; triaging for faster, appropriate specialist care and improvement in patient outcomes and quality.
The ATA letter cited five parts of Medicare section 1834(m) that need to be waived, “as they contain major, arbitrary barriers to ACOs:”
1. Section 1834(m)(4)(C)(i)(II) needs to be waived to permit health service by videoconferencing for the 35 million Medicare beneficiaries who live in one of the nation’s 1,092 metropolitan counties.
2. The last sentence of section 1834(m)(1) must be waived to permit store-and-forward services (such as transmission of medical images) for the 43 million beneficiaries who live outside of Alaska and Hawaii.
3. Section 1834(m)(4)(F)(i) needs to be waived to permit the best judgment of physicians and other practitioners about the medical needs and other circumstances of Medicare beneficiaries.
4. Section 1834(m)(4)(C)(ii) needs to be waived to permit telehealth services originating from a beneficiary’s home, hospice or anywhere else from which a beneficiary seeks service (without regard to an originating site fee).
5. Section 1834(m)(4)(E) must be waived to permit any beneficiary to obtain otherwise covered Medicare services including physical therapy, occupational therapy, speech-language pathology and audiology, among others.
“Given the ACOs’ financial limits and incentives, there is no reason for Medicare’s usual utilization controls on telehealth,” the ATA concluded. “Despite the laudatory statements, in the legislation and proposed rulemaking, the failure to waive these five specific Medicare requirements will effectively prohibit the ACOs from coordinating care.”
However, the Washington, D.C.-based group also called on federal agencies to lift “Medicare’s outdated restrictions” on telemedicine. “The proposed ACO regulations [will] still be subject to formidable statutory restrictions for telehealth services under Medicare Parts A and B as authorized under Social Security Act section 1834(m),” the letter stated.
Congress gives the Secretary of the Department of Health and Human Services the authority to waive this restriction under section 1899(f), “but unfortunately this was not included in the proposed rulemaking. ATA strongly urges the Secretary to waive this restriction. Otherwise, the ACOs will fail to fulfill Congressional and Agency intent,” the ATA stated.
Telehealth should be an integral part of ACOs, the group said. The benefits of telehealth for the Medicare program include reduction of overuse of emergency room visits and preventable inpatient admissions; triaging for faster, appropriate specialist care and improvement in patient outcomes and quality.
The ATA letter cited five parts of Medicare section 1834(m) that need to be waived, “as they contain major, arbitrary barriers to ACOs:”
1. Section 1834(m)(4)(C)(i)(II) needs to be waived to permit health service by videoconferencing for the 35 million Medicare beneficiaries who live in one of the nation’s 1,092 metropolitan counties.
2. The last sentence of section 1834(m)(1) must be waived to permit store-and-forward services (such as transmission of medical images) for the 43 million beneficiaries who live outside of Alaska and Hawaii.
3. Section 1834(m)(4)(F)(i) needs to be waived to permit the best judgment of physicians and other practitioners about the medical needs and other circumstances of Medicare beneficiaries.
4. Section 1834(m)(4)(C)(ii) needs to be waived to permit telehealth services originating from a beneficiary’s home, hospice or anywhere else from which a beneficiary seeks service (without regard to an originating site fee).
5. Section 1834(m)(4)(E) must be waived to permit any beneficiary to obtain otherwise covered Medicare services including physical therapy, occupational therapy, speech-language pathology and audiology, among others.
“Given the ACOs’ financial limits and incentives, there is no reason for Medicare’s usual utilization controls on telehealth,” the ATA concluded. “Despite the laudatory statements, in the legislation and proposed rulemaking, the failure to waive these five specific Medicare requirements will effectively prohibit the ACOs from coordinating care.”