Join the Telehealth Reimbursement Coalition!

One of the highlights of this year’s Spring Executive Telehealth Summit was the inaugural meeting of the Telehealth Reimbursement Coalition. Led by CTeL, and bringing together experts from throughout the industry, as well as leaders on Capitol Hill, this group will be working to make a research-based case for broader Medicare and Medicaid reimbursement for telehealth services—at a time when advocates have increasingly asserted that the limitations that the Centers for Medicare and Medicaid Services (CMS) place on reimbursement are holding telehealth back.

See below for more detailed information about the Coalition, and join our first conference call this Thursday, June 29, at 10 AM. You can register  here!

Background

In 2001, when telehealth was still in its comparatively early stages, advocates for reimbursement presented findings to the Congressional Budget Office (CBO), the nonpartisan entity that assesses the potential fiscal impact of proposed legislation, in support of Medicare reimbursement for telehealth services (this was shortly after the passage of telehealth-related legislation in Congress). However, the CBO had concerns about the degree to which telehealth would reduce costs for Medicare; these misgivings led them to put in place the restrictions, including originating site and geographic limitations, that frustrate patients and providers today. Even with these restrictions, CBO significantly misjudged the cost of federal telehealth spending. Today, the members of the Telehealth Reimbursement Coalition and their Hill allies are seeking to present the CBO with a base of research that clearly demonstrates telehealth’s ability to reduce health care costs—or at least that it is cost-neutral. The Coalition’s three core teams are aiming to complete their work by October.

What have coalition members been doing?

  • Identifying relevant research. Drawing on existing research is the foundation of any academic study, and is a crucial part of what the Coalition is doing. Some members are using specialized search tools to identify studies that could bolster the case for expanded reimbursement with the CBO. Not all studies, of course, are created equal, and the goal is to only include studies with clear data on costs, or that examine the utilization of telehealth as either a complement or a substitute for traditional health care delivery. But there have been some promising initial findings, including one study that showed decreased costs from the use of tele-mental health services; meanwhile, the research is continuing.
  • Sharing the patient/provider perspective with utilization data. Other members are focusing on the provider and health-system experience of utilizing telehealth—including its impact on access to care. As more and more organizations build telehealth into their standard of care, Coalition members told meeting participants, the better the position we will be in to influence the CBO.
  • Identifying successes, including with federal payers, and using that data. One example of the successful use of telehealth has been at the Veterans Administration (VA), where about 700,000 veterans received care through virtual visits last year. The visits have generated some good outcome measures—for example, a reduction in bed days of care and in spending on travel. Telepsychiatry has been particularly useful for this population; now, as the agency looks to grow the number of patients utilizing telehealth services, they are also looking to expand home care and remote monitoring programs.

What are some of the challenges that have arisen?

  • Not all studies are created equal. Some of the current studies of the utilization of telehealth are not well designed, or are outdated, or don’t include data on cost savings. At the same time, existing research is crucial to our efforts.
  • There is a limited window of time between now and October—the Coalition’s deadline. Ideally, the Coalition would have time to build a complete “data warehouse,” but the time frame will likely not allow for that. To that end, members suggested reaching out to other groups and organizations as potential collaborators, whether to provide existing data or to conduct additional research.
  • Data from different studies is presented in different ways. How should data, especially coming from different studies using different metrics, be presented in a consistent way to the CBO? This is an ongoing challenge that the Coalition will need to address.

What still needs to be done, and how should we work toward it?

What does the Coalition need as it moves forward? Members shared their goals and their potential ideas.

  • Help in building a body of research, complete with real data from clinical work, that clearly demonstrates the efficacy of telehealth. Simply put, there is a need for more research, and for more data. For example:
    • Medicare and Medicaid data on utilization and costs.
    • Private payer data on utilization and costs.
    • Evidence from new practice models.
    • In the long term, new data from studies authorized by Congress.
  • Clear examples of “low-hanging fruit” across studies and from clinical data. There are common threads throughout studies when it comes to successful telehealth programs. One example that came up during the Coalition meeting was that of telestroke, which several members noted has been effectively implemented in a number of settings. Members suggested potentially setting up a patient registry to gather data on telestroke care’s successful use.
  • Help in defining “cost savings” in a consistent way. One member pointed out that there is a gray area between “cost prevention” and “cost savings” when it comes to data. Another pointed to the importance of setting clear benchmarks for measuring cost savings, particularly in the long term, and of accounting for the initial costs of setting up telehealth programs, which could lead some to wrongly conclude that it doesn’t lead to money being saved. What’s more, different providers across different specialties see savings in different ways, and not all studies focused on cost savings are focused on the same specific costs. Still others examine quality and don’t really consider costs. All of this makes it important to arrive at a more consistent definition of “cost savings.”

In conclusion

All in all, the first meeting was a productive one, highlighting both the work that had been done thus far and what remains to be done. Ultimately, as one member pointed out, the group wants the CBO and everyone to understand that telehealth is simply another form of care delivery. What’s more, the goal is to arrive at a place where there’s no longer the need to prove to a wider audience that telehealth works—and that’s what the Coalition is working toward.

We know that, with telehealth, we have the potential to create lasting, positive change in the American health care system. Please send along your thoughts and suggestions—we encourage you to get involved in our efforts to make the case for telehealth with the CBO. And join our first meeting this Thursday at 10 AM!

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One Comment


  1. Elva Roy
    Jul 14, 2017

    I lead a group of ~375 people 50+ in Arlington, Texas. This is a community group. We don’t sell anything and we don’t charge any fees. We educate and advocate. I am a big proponent of telemedicine and have educated my group about the benefits and I have been a speaker at community meetings to educate others about what telemedicine is. I WANT Medicare to reimburse providers for telemedicine visits (not just in rural areas). I have followed/am following various bills in Texas (SB 1107) and in the U.S. Congress (S.787). If there is any way I can contribute here, please advise.

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