Medicare is Holding Telehealth Back: New GAO Study

Study after study, it seems, has pointed to the cost savings and enhanced health outcomes that could result from the broader implementation of telehealth and remote monitoring. But according to a recent Government Accountability Office (GAO) study, outdated Medicare reimbursement policies and other coverage limitations are standing in the way of wider utilization. As Health Data Management first reported, GAO researchers found relatively limited usage of the technologies, and also identified a series of barriers to more widespread implementation. Specifically, those interviewed for the study “reported that both telehealth and remote patient monitoring may improve or maintain quality of care in Medicare, but they rated concerns regarding payment and coverage restrictions as potential barriers,” GAO researchers noted.

Authorized as part of the 2015 Medicare Access and CHIP Reauthorization Act, the study included interviews with provider groups, payer associations, and other industry stakeholders. (Along with Medicare, the researchers also examined telehealth utilization through Medicaid, the Department of Defense, and the Department of Veterans Affairs.) Explained GAO researchers, “Officials from a provider association reported that Medicare’s telehealth policies for payment and coverage lag behind other payers due to the program’s statutory and regulatory restrictions.” More specifically, “these restrictions limit the geographic and practice settings in which beneficiaries may receive services, as well as the types of services that may be provided via telehealth and the types of technology that may be used.” Also making things more challenging: limited broadband coverage and other infrastructure-related issues, and a lack of access to (and understanding of) telehealth technologies.

Gary Capistrant, who serves as chief policy officer at the American Telemedicine Association (ATA), suggested that the new report’s findings might be an impetus for Congress to step up their efforts when it comes to supporting the increased utilization of telehealth and remote monitoring. “We hope that Congress will stop asking for studies and soon include expanded Medicare coverage of telehealth, especially for Medicare Advantage and other plans bearing the full financial risk for the cost of care,” he told Health Data Management. Indeed, as CTeL recently reported, some lawmakers have already introduced legislation that would expand Medicare reimbursement for telehealth technologies. On April 6, Senate Finance Committee leaders announced the introduction of S. 870, the CHRONIC Care Act; the bill, which is aimed at improving the quality of care for high-cost patients enrolled in Medicare, includes key telehealth provisions. At the end of March, Sen. Cory Gardner (R-CO) and Sen. Gary Peters (D-MI) introduced S. 787, the Telehealth Innovation and Improvement Act, which would expand Medicare’s coverage of telehealth services by permitting eligible hospitals, through the Center for Medicare and Medicaid Innovation (CMMI), to test the increased use of telehealth care. In February, Sen. John Thune (R-SD) and Rep. Morgan Griffith (R-VA) introduced versions of the Furthering Access to Stroke Telemedicine (FAST) Act in both chambers. The bill, which seeks to expand access to telestroke care, has drawn bipartisan support on both sides of the Capitol.

Click here for the article from Health Data Management on the recent GAO telehealth study.

Click here for the GAO study on telehealth utilization. 

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