Industry associations have written to the Congressional Telehealth Caucus, responding to the group’s request for information (RFI) concerning opportunities to leverage telehealth and remote patient monitoring (RPM).
The College of Healthcare Information Management Executives (CHIME) and America’s Health Insurance Plans (AHIP) were two groups that addressed some of the biggest barriers to telehealth growth, while offering recommendations in their letters to the Caucus.
The Congressional Telehealth Caucus was formed in 2017, with Reps. Mike Thompson (D-CA), Gregg Harper (R-MS), Diane Black (R-TN), and Peter Welch (D-VT) the original leaders of the bipartisan committee. In March, the group, now with 10 members, published an RFI asking for help and guidance in crafting “comprehensive telehealth legislation for the 116th Congress.”
The request comes at a crucial time as telehealth bills continue to get introduced and work their way up in Congress. In its letter, CHIME wrote, “In discussing the questions posed under the RFI, CHIME members highlighted that although the technology may be available, and interest exists among providers and patients to leverage telehealth and RPM technologies, the communications requirements to effectively use such technologies may render the programs useless.”
One significant barrier that hinders telehealth and RPM adoption by patients and providers, CHIME said, is broadband access. It pointed to a recent Federal Communications Commission (FCC) report which found that 23 million rural Americans lack broadband at benchmark speeds. As such, CHIME noted that it suggested the government double the funding available under its Rural Health Care (RHC) Program from $400 million annually to $800 million. “Ultimately the [FTC] opted for a 40 percent increase to $571 million, the first such increase since the program was created in 1992. This increase will allow greater reach of telehealth in rural and remote areas, yet more help is needed to keep pace with demand,” CHIME wrote, while also highlighting the promise of 5G networks, which it said “may not only remove existing access barriers but also unlock the ability for the world's best doctors and specialist to diagnose and treat patients in these areas.”
Reimbursement issues were also highlighted by CHIME. “Our members regularly cite their organizations’ telehealth and RPM programs as being too limited as they do not align with existing healthcare business models in which payment is predicated on visits. Although Medicare has slowly incorporated additional telehealth services into their reimbursement models, including telestroke and teledialysis as outlined in the CONNECT for Health Act and ultimately included in the Balanced Budget Act of 2018, there are still significant geographic and definitional limitations,” the association wrote.
CHIME specifically noted that coverage gaps among states and differences in state laws, definitions and regulations “create a confusing environment for hospitals and health systems that may care for a patient across state lines.”
To this point, AHIP wrote that one of the most significant challenges relates to state licensure of providers. “Each provider’s ability to deliver care via telehealth across state lines is determined by the provider’s license—providers must be licensed both in the states where they are located and where the patient is located. This limits the value of a ‘national’ network of providers via telehealth and the ability of telehealth to expand patient access to services, reducing the impact of providing care from a remote location,” AHIP wrote.
As such, CHIME is calling on the Caucus, as well as the Centers for Medicare & Medicaid Services (CMS) and other payers, to redefine what constitutes a telehealth visit. In the letter, CHIME pointed out that a CIO of a large health system said her physicians get reimbursed for a telehealth visit if they spend 30 minutes with a patient. “However, in leveraging telehealth the doctor often does not need to spend 30 minutes with the patient as they are likely to have their health history and, if combined with remote monitoring, access to additional data points to augment the patient consultation. Telehealth visits should not be constituted by the length of the visit, instead, for the services provided,” CHIME said.
AHIP also pointed out the inconsistent rules, from state to state. It gave examples of how in Georgia, counselors and licensed clinical social workers are required to obtain telemental training prior to delivering care. But many states differ in which types of provider can deliver care via telehealth; in New York, certified asthma educators and certified diabetes educators are allowed to deliver care via telehealth, whereas these services are not supported in Minnesota or Texas. “Congress must take action to remove these barriers and expand access to telehealth services,” AHIP wrote.
Meanwhile, both groups noted that the Substance Use Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act of 2018 included several valuable provisions expanding access to telehealth for various patient populations, such as removing originating site and geographic restrictions and waived originating site fees for the treatment of high-need conditions, such as substance use disorder treatment. CHIME and AHIP both wrote that they support Congressional efforts that build on these policy changes. “We believe that numerous other patient communities could benefit from similar flexibility,” AHIP said.
