The Medicare Payment Advisory Commission (“MedPAC”) recently met in Washington, DC, to conduct its monthly assessment of the issues and challenges facing the Medicare program. Their November meeting marked the third consecutive monthly meeting at which MedPAC discussed telehealth as mandated by Congress in the 21st Century Cures Act of 2016. In previous meetings, the commissioners reviewed how Medicare and commercial health plans currently cover the technology.
This past summer, MedPAC surveyed health programs, Medicare beneficiaries, primary care physicians, and home health agencies with the goal of better understanding their use and attitudes toward telehealth. Results of this survey show that despite the success of certain telehealth programs for health plans (e.g., tele-stroke, tele-mental health) and the increased use of telehealth services among home health agencies, many of those surveyed believe that telehealth provides convenience and improves care only in limited circumstances.
For its November meeting, MedPAC staff presented ways in which telehealth services covered under private insurance plans might be incorporated into the Medicare fee-for-service program and their recommendations for ways to accomplish this incorporation. Their report included a definition of telehealth, a comparison of Medicare and commercial plan telehealth coverage, principle for evaluating coverage expansions and also illustrative examples of policy options. Examples included direct-to-consumer care through companies like Teladoc or American Well, drug management, nursing home care and remote patient monitoring for chronic diseases.
MedPAC is in the final stages of assembling their recommendations to Congress. MedPAC is planning to discuss the full telehealth report in January 2018 and is forecasting that its report will include a recommendation that Congress grant Medicare Advantage plans the flexibility to include telemedicine in their annual bids to CMS. MedPAC is also planning to recommend that risk bearing entities such as Accountable Care Organizations (ACO) and Medicare Advantage plans be granted greater flexibility to cover telemedicine services. For services where tele-medicine’s value is unclear, MedPAC could recommend that CMS consider testing services through its Innovation Center.
The MedPAC commissioners will finalize their recommendations in January for the formal report to Congress which will be delivered to Congress by March 15, 2018.