Current Medicare coverage for telehealth services is a barrier to the growth of such offerings in hospitals, suggested Rick Pollack, executive vice president of the American Hospital Association, in a letter to Rep. Fred Upton (R-Mich.), chairman of the Committee on Energy and Commerce.
The letter, written on behalf of the AHA, responds to the committee's discussion draft of legislation "Advancing Telehealth Opportunities in Medicare."
Medicare's coverage of telehealth services is lacking compared to the private sector and many state Medicaid programs, and at least 20 states require private payers to pay the same amount for services whether they were delivered in-person or online, according to the letter.
The AHA suggested the following four restrictions should be addressed in order to "modernize" Medicare coverage and payment for telehealth services.
1. Geographic restrictions. As it stands, Medicare only pays for telehealth services provided to patients from a rural locations designated as shortage areas. However, the AHA noted even metropolitan cities suffer physician shortages, and access to certain specialties is limited across all geographic areas. Additionally, "the almost ubiquitous use of communications technology in American life today has created growing consumer expectations that, where safe and appropriate, healthcare services also can be accessed remotely, regardless of where the individual is located," the letter reads.
2. Covered services. Medicare only covers a small number of services, including consultations, office visits, pharmacological management and diabetes self-management training services, according to the letter. Just 75 service codes of 10,000 physician services are approved for payment when delivered online, a "stark contrast" to what private payers cover.
3. Patient originating site. Only patients who are seen via telemedicine at a specified originating site — a hospital, skilled nursing facility or physician office — can receive coverage for that service. "As our nation's telecommunications infrastructure grows, however, it will be increasingly possible to safely provide care to patients in other settings, including, potentially, the office, school or home," according to the letter.
4. Approved technologies. Medicare only covers telehealth services delivered through real-time video-and-voice telecommunications systems, so services requiring remote monitoring technologies, for example, are not covered, according to the letter.
"Given the growing body of evidence that telehealth increases quality, improves patient satisfaction and reduces costs, we believe a more global approach to expanding Medicare coverage of telehealth is warranted," the letter concludes.