The Alliance for Connected Care is using the Centers for Medicare and Medicaid Services' recent appointment of its new administrator, Dr. Mehmet Oz, as an opportunity to advocate for digital healthcare initiatives such as expanded access to virtual care and telehealth.
In a letter to CMS last week, the Alliance said that there are "antiquated restrictions" on care that "stand in the way of our technology-enabled future."
Currently, the Alliance said, CMS allows practitioners to render telehealth services from a location such as their home without reporting it as an additional billing location. That allowance will end on Dec. 31.
What makes that a problem, according to the Alliance, is that differentiating and reporting home addresses on billing and enrollment forms would result in a projected 40-fold increase in the number of billing addresses tracked and reported to CMS by a health system. Multiple health systems estimated the resulting operating costs of this change at about $1 million in labor. CMS itself would see significant operating costs.
The Alliance is advocating for CMS to make the allowance permanent and to create a separate pathway for fully virtual providers who lack a brick-and-mortar location.
The group also wants CMS to drive more efficient and coordinated care for those with chronic disease by ensuring adequate reimbursement for remote patient monitoring technology. The decline in RPM reimbursement, the Alliance said, is a barrier for most Medicare beneficiaries to receive certain services.
WHAT'S THE IMPACT
In addition to those policy priorities, the Alliance said it's time to treat telehealth access as though it's equal to in-person care when considering network adequacy requirements in Medicare Advantage and Medicaid. It pushed for more outcome-focused tools, such as beneficiary access, satisfaction and wait times for providers – either in-person or delivered virtually.
Meanwhile, CMS has permanently allowed virtual direct supervision for lower acuity healthcare services, but has yet to fully enable virtual supervision to increase efficiency and access in Medicare, the Alliance found – a move for which it has advocated.
It also pushed for reducing restrictions on interprofessional consultations, which the Alliance touted as a mechanism by which treating providers can request the opinion of another provider with specific specialty expertise; the latter assists in diagnosis or disease management without seeing the patient. These e-consults, the Alliance said, provide clinical value and can reduce referrals to specialists, thereby reducing costs to Medicare.
Setting its sights on the Drug Enforcement Administration, the Alliance said that "overbroad" restrictions being considered by the DEA may result in Medicare beneficiaries having restricted access to telehealth. In January, the DEA released a proposed regulation that would, in the Alliance's view, limit telehealth options when a controlled substance is required for treatment, with mental health treatments being disproportionately impacted.
The letter calls on CMS to publish a rule focusing on its "core role of preventing the diversion of controlled substances."
THE LARGER TREND
While the Alliance pushed CMS to extend telehealth flexibilities, Congress must act on those flexibilities, which remain in effect until Sept. 30.
The Senate on Thursday confirmed the nomination of Oz as CMS administrator.
Oz takes the helm of CMS amid a political divide surrounding potential Medicaid budget cuts, hikes to ACA premiums if tax subsidies are not extended and the controversial appointment of Health and Human Services Secretary Robert F. Kennedy Jr.
Last week, RFK Jr. began a sweeping overhaul of HHS that included cutting roughly 20,000 jobs through layoffs, early retirement and voluntary separation offers.
Oz has not said yet whether he would oppose such cuts to the government-funded program, according to AP. Oz did say during a Senate Finance Committee hearing last month that he supported work requirements for Medicaid recipients.
Jeff Lagasse is editor of Healthcare Finance News.
Email: jlagasse@himss.org
Healthcare Finance News is a HIMSS Media publication.