Government health care policy-makers met last week to discuss ways to expand incentives for health care providers to use telemedicine applications and systems.
Members of the American Health Information Community (AHIC)’s chronic care workgroup met to try to remove rules that allow providers of remote health care to be reimbursed by Medicare only if they work in specific geographic areas and clinical settings.
Access to remote health care — or telemedicine — has increased with the expanded use of health information technology. Now workgroup members are working to develop recommendations for the Health and Human Services Department to better define the term, or eliminate it all together, because of those strict limitations.
Dr. Karen Bell, director of HHS’ Office of Health IT Adoption, told the group that the Balanced Budget Act of 1997 and the Medicare Modernization Act of 2003 are two important pieces of legislation that contain restrictions that are currently affecting the advancement of telemedicine.
“The bottom line is that these statutes place some limitations on reimbursements for telehealth and they will affect any type of legislation that comes from Medicare,” Bell said. “Medicare still has to abide by the statutory limitations in place.”
In a previous meeting, workgroup members were told that revising the billing codes physicians use to get reimbursed for services is not under the authority of the Centers for Medicaid and Medicare Services (CMS) and would require HHS input and perhaps new legislation.
However, Robert Waters, an attorney at Drinker, Biddle, Gardner Carton, said there is still room for interpretation in the current legislation regarding which clinical settings — such as doctors’ offices and hospitals — are authorized for telemedicine.
“There are several opportunities to push the limits as to what is defined as the extension of a doctor’s office through the use of technology,” Waters said. He added, however, that although technology now allows physicians to communicate with patients from home, expanding the list of acceptable sites to include providers’ homes will probably require a change in statute.
Sharon Bee Cheng, a senior analyst of the Medicare Payment Advisory Commission (MedPAC) — an independent group that advises Congress on issues concerning Medicare — said the Commission is encouraging the use of IT for telemedicine and has made steps to financially reward providers who use telemedicine in their practices.
She said that telemedicine services, such as a 24-hour nurse call line, are of great benefit to reducing consumers’ use of hospital emergency rooms and can provide considerable quality care.
“We would like Medicare to pay more for quality and believe pay for performance can change some incentives [and increase participation from providers],” Cheng said. “In doing that, we will encourage IT.”
Cheng also reminded the group of MedPAC’s 2005 recommendation to CMS that pay for performance should include measures of IT functionality.
She said examples of providers’ IT functionality include having a registry for patients with chronic conditions, a system that tracks test results and prompts providers to follow up on abnormal results, and a system that notifies patients of lab results.
Cheng said MedPAC realizes that although IT has considerable potential to improve quality care, its use is still low among providers.
“We understand this is mainly because of the barriers in the system and the misalignment of the use of IT and payment for services,” she said. “Physicians know if they replace an office visit with a telehealth consultation, they may not get reimbursed for the service.”
The workgroup will reconvene in June to readdress these barriers and establish their recommendations for change. Once complete, they will be passed on to AHIC for consideration.
From the battlefield to the home front: Managing medical data
Government Health IT presents Col. Claude Hines Jr., program manager for the Defense Health Information Management System, in this recent InSight eSeminar. Col. Hines discusses the health information technology and tactical challenges faced by the military medical community in Iraq, Afghanistan and other areas of conflict. In doing so, he describes the current information technology solutions for transferring clinical data between battlefield care givers to health care personnel at military treatment facilities worldwide.
