TIA Blog

Those who are familiar with TIA's priorities in the healthcare space know that we have consistently urged policymakers for much wider support of telehealth and remote patient monitoring than what is in effect today. This priority is based on a well-established (and growing) body of data which demonstrates that these advanced solutions result in increased quality of care; reduced hospitalization; avoidance of complications and improved patient satisfaction, particularly for the chronically ill; and reduced costs, among other benefits.

While this concept finds general agreement amongst stakeholders almost universally, the true challenge that has emerged is how to affect policy changes that will help us realize these benefits.

A key agency in this challenge is the Department of Health and Human Services' Centers for Medicare & Medicaid Services (CMS), which administers Medicare and Medicaid, and other Medicare payment policies to ensure that the payment systems are updated. With policies in place that greatly restrict the use of telehealth and remote patient monitoring, how does CMS demonstrate adequate grounds for making such changes? One answer is through CMS' Center for Medicare and Medicaid Innovation (CMMI).

The mission of CMMI, established under the Affordable Care Act, is to develop and test innovative payment models and methods for the delivery of health care, with the goal of improving the quality of care and reducing overall costs for Medicare, Medicaid, or Children's Health Insurance Program (CHIP) beneficiaries.

Recently, CMMI requested public input from stakeholders on possible initiatives to test different Health Plan Innovation Model concepts. This request sought information on initiatives that would allow health plans to include a broader range of remote access technologies in the basic benefits package beyond the telehealth services that are currently covered under Medicare.

As a longtime advocate for increased adoption of advanced technologies in the health care space, on November 3rd, 2014, TIA submitted comments to CMMI urging for the prioritization of telehealth and remote monitoring services.

Benefits of Advanced ICT Solutions in Healthcare Services

Statutory restrictions on telehealth coverage (Section 1834[m] of the Social Security Act) have excluded millions of Americans from the proven benefits of these transformative technologies that we discuss above. These arduous restrictions have long been a hindrance to progress in this space, negatively impacting investment and innovation.

While CMS cannot control the letter of the law in 1834(m) – except in some circumstances where these restrictions can be waived by the HHS Secretary – it is encouraging that CMS continues to explore innovative delivery mechanisms that harness these technologies, such as a CMMI Independence at Home pilot program that is using remote monitoring and mobile diagnostic technologies, and a George Washington University project that is "using telemedicine in the peritoneal dialysis to improve patient adherence and outcomes, while reducing overall costs."

Further, the recently released 2015 Physician Fee Schedule also has a provision that would pay for remote chronic care management services. While these are positive steps, many challenges remain for the ICT manufacturer, supplier, and vendor community before the full potential of advanced ICT solutions in the healthcare space can be reached. TIA will continue to urge CMS and other Federal agencies to utilize every opportunity to employ these advanced technologies towards the goal of a more efficient and effective health care system.

TIA Recommendations to CMMI

Specifically, TIA urged CMMI, as it looks at model tests that allow greater use of remote access technologies, to:

• Examine remote patient monitoring for congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and diabetes, building towards the further expansion for eligible chronic conditions identified by the Secretary of Health and Human Services based on an annual review of the evidence;
• Recognize that remote patient monitoring of patient-generated health data (PGHD) is increasingly proving to be an integral aspect of any healthcare system, and to issue grants that build upon the growing body of evidence; and
• Use every opportunity to utilize these advanced technologies and work towards a more connected health care system, prioritizing technology and platform-neutrality in CMMI program examinations.