Last month, the Senate Finance Committee passed a bipartisan bill aimed at strengthening and improving health care outcomes for chronically ill Medicare beneficiaries. The committee unanimously approved the Creating High-Quality Results and Outcomes Necessary to Improve Chronic (CHRONIC) Care Act of 2017 in a 26-0 vote on May 19 (see the May 22, 2017 Center for Health Solutions’ blog by Ryan Haggerty). The legislation would allow Medicare Advantage plans to develop benefits specific to chronic conditions including cancer, diabetes, and Alzheimer’s disease; and would promote the use of telehealth to allow more chronically ill Medicare beneficiaries to receive care at home.
Specific telehealth provisions include allowing:
- Medicare to pay for remote stroke diagnosis and treatment;
- Accountable Care Organizations to provide telemedicine; and
- Medicare Advantage plans to offer telemedicine as a supplemental benefit, as well as pay for home dialysis treatment at home through telemedicine.
A preliminary CBO report estimates that the four telemedicine-related sections of the bill would increase Medicare spending by $150 million over a decade. Concerns that telehealth may increase costs have stalled similar telehealth initiatives in the past. The movement of this bill could signal that there is strong interest in advancing telehealth policy for the chronic care population.
Related: A study published in this month’s Annals of Family Medicine showed that patients who use telehealth as part of their primary care visits are satisfied, and would be interested in continuing telehealth visits as an alternative to in-person visits. The team from Thomas Jefferson University Hospital analyzed data from in-depth qualitative interviews of a small sample of patients (19 adults) after video visits with their primary care clinician. The team found that all patients reported overall satisfaction with the video visits, and most were interested in continuing to see their primary care clinician via video visit. They reported that convenience and decreased costs were the main benefits. Some of the patients also reported feeling more comfortable during the visit, and preferred being in their own supportive environment if they received news about serious health issues. However, some participants cited concerns, including lack of privacy (if they were at work) and lack of ability to receive a physical examination.
Deloitte’s 2016 Survey of US Health Care Consumers found that consumers are open to telehealth. About half of surveyed consumers, whether they had a chronic condition or not, said they would use telemedicine for post-acute care or chronic condition monitoring. Consumers seem less interested in using telemedicine for acute conditions such as sore throats, rashes, and minor injuries. About one-third of surveyed consumers said they had no concerns about using telemedicine. However, 43 percent were concerned about quality of care being lower than if they saw a clinician in person, while 35 percent had privacy and security concerns.
Analysis: An aging population, increasing chronic illness and the importance of self-care, accelerating health costs, regulatory reform, and new payment models are driving interest and growth in telehealth. Some recent studies show that telehealth visits are associated with lower costs than traditional in-office visits and could save money in Medicare. However, some policy analysts say that increased access to telehealth could increase costs in a fee-for-service system.
Until recently, Congress has been slow to move on telehealth. Over the years, many bills have been in the works without passage. Congress did, however, pass the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which included policies that could encourage greater use of telehealth. MACRA may increase telehealth adoption by both clinicians in Alternative Payment Models (APMs) and those remaining in traditional FFS. Telehealth will likely be a useful tool under MACRA because providers will be required to extend their reach beyond the office setting as they aim for more holistic, quality care that avoids costly and unnecessary services. Additionally, MACRA encourages organizations to enter into new payment and delivery models, which should promote collaboration between health plans and hospitals around telehealth and other technology-based patient services.
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