MACRA and the Future of Telehealth
In October, the Centers for Medicare and Medicaid Services (CMS) released the Final Rule implementing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This rule, which is nearly 2.400 pages in length, is intended to lay the foundation for the future of the Medicare reimbursement system with the intent of rewarding clinicians for delivering quality care to their patients. The rule finalizes the details of the Quality Payment Program (QPP), which includes the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) track.
The MIPS path is designed for healthcare providers who currently practice in a traditional, fee-for-service environment. According to the rule, these providers will be able to ease their way into the new payment system. The advanced APM track is designed for those providers who are already participating in specific value-based models of care delivery.
The use of telehealth will likely be encouraged under MACRA because providers will be rewarded for delivering more holistic, quality care while avoiding costly and unnecessary services. Many telehealth advocates and analysts hope that the value of telehealth services will be demonstrated through various CMS initiatives and models which will then form the foundation for expanding coverage in Medicare, according to a Deloitte report.
Telemedicine has the ability to increase access and quality of healthcare services, while also decreasing costs, making it an invaluable tool as we shift from a fee-for-service payment model to value-based care. Telehealth services can be especially useful in improving outcomes for chronically ill patients. For example, in 2012 the Veterans Administration (VA) served over 150,000 beneficiaries with telehealth services. These services were associated with a 25% reduction in number of bed days and a 19% reduction in hospital admissions across all VA patients using telehealth, which is an average annual savings of $6,500 for each patient, equating to nearly $1 billion in system-wide savings.
According to a press release from the Department of Health & Human Services (HHS), the Final Rule is “informed by a months-long listening tour with nearly 100,000 attendees and nearly 4,000 public comments.” One of the many groups submitting extensive comments to HHS was the Connected Health Initiative (CHI) which resides under ACT/ The App Association in Washington, DC. The CHI submitted comments advocating for leveraging the power of telehealth solutions.
In response to the Final Rule released by CMS, the president of ACT’s Connected Health Initiative, Morgan Reed, released the following statement:
After review, we are disappointed to conclude that CMS’ recently released MACRA rule does little to embrace the power of connected health tech to advance patient care. Specifically, CMS has opted to rely on a backwards-facing ‘telehealth’ definition over 15 years old, precluding the vast majority of innovative connected health technologies available today.
We struggle to understand how CMS has adequately satisfied Congress’ specific requirement that ‘telehealth and remote monitoring’ be leveraged in the new program’s Clinical Practice Improvement Activities.
CMS is accountable to Congress to improve the efficiency and quality of care for patients, both inside and outside of the four walls of the hospital. It is clear that CMS failed to take Congressional intent into consideration when it comes to new technologies and telehealth. CHI will continue to press the Medicare system on improving lives by using connected health technology.
We support the Connected Health Initiative as they continue to lobby members of Congress and the Senate to push Medicare towards more integration with the connected health domain. We share the belief that CMS reimbursement models should serve to encourage clinicians in the use of innovative connected health technologies to improve care for their patients while reducing the overall costs of care delivery.