Improving Care for Chronic Illnesses

On October 27, 2016, Senate Finance Committee Chairman Orrin Hatch (R-Utah) along with Senators Ron Wyden (D-Ore), Johnny Isakson (R-Ga), and Mark Warner (D-VA) released a discussion draft on their proposed “Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2016”.

The proposed act contains bipartisan proposals to improve health outcomes for Medicare beneficiaries living with chronic conditions while some of the proposals discuss using telehealth to help the chronically ill.

One proposal would expand access to home dialysis therapy which requires a Medicare beneficiary receiving treatment to have a monthly clinical assessment with their clinician. Today, Medicare beneficiaries can utilize telehealth to receive the monthly assessment only if it occurs in an authorized originating site and located in a rural HPSA or area county outside a MSA.

The new discussion draft discusses how beneficiaries on home dialysis would be able to receive monthly clinical assessments using telehealth beginning in 2018. Specifically, it would expand the originating sites to include freestanding dialysis facilities and also provide dialysis in the patient’s home.

Furthermore, it would allow telehealth visits to be conducted without geographic restrictions but still a beneficiary would be required to have a face-to-face assessment with a nephrologist at least once every three months.

Another proposal would increase convenience for Medicare Advantage (MA) enrollees through telehealth. These services would be remote patient and physician and/or other professional face-to-face services delivered via a telecommunications system.

Today, Medicare beneficiaries may receive telehealth services in a variety of settings under current law but the Medicare program recognizes and pays only for certain Part B telehealth services.

The draft proposes that an MA plan would be able to offer additional, clinically appropriate telehealth benefits in an annual bid amount beyond the services that currently receive payment under Part B.

Another proposal in the discussion draft would enable ACOs to expand the use of telehealth. There is nothing to prevent ACOs from providing telemedicine or other technologies that they believe promote efficiencies, however, these services and technologies are not separately paid for by Medicare.

It is proposed in this section that the next generation ACO telehealth waiver criteria would eliminate the geographic component of the originating site requirement. This would allow beneficiaries assigned to the approved Medicare Shared Savings Program (MSSP) and ACO programs to receive currently allowable telehealth services in the home.

The draft document also seeks to expand the use of telehealth for individuals experiencing  strokes. Medicare will pay a physician at a distant site for consulting on a patient experiencing acute stroke symptoms via telehealth if the originating site hospital where the beneficiary presents is in a rural HPSA or a county outside an MSA.

This would enable patients presenting with stroke symptoms to receive a timely consultation via telehealth that could be used to determine the best course of treatment beginning in 2018. Specifically, it would eliminate the geographic restriction to permit payment to physicians furnishing the telehealth consultation service in all areas of the country. The hospital where the patient is present and where the telehealth consultation is initiated would not receive a separate originating site payment. has the Discussion Draft Section by Section Summary of the “Creating High-Quality Results and Outcomes Necessary to Improve Chronic Care Act of 2016”.

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