As a flurry of telehealth-related bills work their way through Congress, a not-for-profit telehealth research group is working to provide the Congressional Budget Office with data to prove telemedicine can save the federal government money. There are at least four pieces of telemedicine legislation currently pending on Capitol Hill, and telehealth advocates are concerned previous CBO scores that overestimated the cost of telemedicine could hold back such legislation.
Many Medicaid programs include telehealth coverage and 34 of 50 states require telehealth parity under private insurance. However, Medicare coverage of telehealth is relatively limited and the Congressional Budget Office has previously said expanding that coverage would come with a cost. CBO publicly scored telehealth legislation in 2001 prior to Congress passing a law to allow Medicare to pay for telemedicine for rural patients in certain areas, and said the provisions would cost up to $150 million over five years. But the legislation ended up costing only $57 million over the next 14 years.
The Center for Telehealth and e-Law (CTeL)'s Telehealth Reimbursement Coalition is collecting data and research on the costs of telehealth from thousands of hospitals, providers, and insurers. The organization began the project after hearing from Congress that CBO scoring based on the 2001 model was holding back telehealth bills. CTeL began gathering data on telehealth costs in June, plans to present an interim report in October and expects to provide their final piece to the CBO by the second quarter of 2018.
Not all telehealth legislation faces trouble with the CBO, though. In a preliminary estimate, the agency deemed the Medicare Part B Improvement Act, which would expand the role of telehealth in home dialysis, would save $4 million over 10 years. The CBO also estimated that the legislation would reduce costs for Medicare beneficiaries who switch from receiving infusions in a hospital setting to receiving infusions in a home setting.
Yet the cost of telehealth legislation has proved to be a barrier.
"It's clear right now that this Congress isn't going to add any legislation that will add to the federal budget, so any telemedicine legislation needs to either save money or be cost neutral," CTeL Deputy Executive Director Christa Natoli said.
In the Senate, the Finance Committee's chronic care bill and the CONNECT for Health Act and would expand telemedicine use in Medicare. The Senate Finance Committee unanimously passed its Medicare chronic care bill, which would expand telehealth services by eliminating geographic restrictions on telestroke consultation services, expand telehealth coverage under Medicare Advantage, and give Accountable Care Organizations more flexibility to use telehealth services. Committee Chair Orrin Hatch's (R-UT) office anticipates the legislation will be taken up by the full Senate this fall. Chief Policy Officer of the American Telehealth Association, Gary Capistrant, speculated that the Senate was probably waiting for a final CBO score to determine whether to include telehealth provisions in the Finance Committee's chronic care bill "as a stand-alone bill or as part of the bundle."
CBO released a score of the bill Tuesday (Aug. 1) that estimates expanding Medicare reimbursement of telemedicine would cost $150 million over a decade. The office estimated that expanding the use of telehealth for stroke would cost $180 million over 10 years and expanding the use of telehealth in ACOs would cost $50 million, though those provisions would be partially offset by expanding the use of telehealth in Medicare Advantage.
In the House, the Evidence-Based Telehealth Expansion Act and the FAST Act, as well as the Medicare Part B Improvement Act, all aim to expand Medicare coverage for telemedicine.
A bipartisan group of lawmakers in the House Energy & Commerce Committee's telehealth group, Rep. Doris Matsui (D-CA) and Rep. Bill Johnson (R-OH), introduced the Evidence-Based Telehealth Expansion Act on Thursday (July 27). The legislation would make one part of the CONNECT for Health Act a stand-alone bill.
Matsui's office said the bill is an effort "to continue the current momentum on telehealth." Matsui's health care legislative aide said her office hopes "to move things forward with telehealth, but we haven't seen a lot of progress… in the event additional attention is paid to telehealth we'll have some policy ready to go."
The proposed legislation would allow the HHS secretary to review existing services in the Medicare program to determine which are fit for telehealth, and then waive current restrictions to those. It would also require the CMS actuary to certify that the expanded services will not increase program costs.
Johnson told Inside Health Policy that he hopes this bill "could also potentially help with the CBO scoring issues that telehealth policy always runs into" more generally.
"The world is catching on to telehealth and that Medicare is one of the laggers here. So there is a need and an opportunity that are coming together," Capistrant said of the telehealth legislation popping up in Congress. He added that as telemedicine policy gains popularity, "more and more members want to put their name on legislation," and are taking pieces of telehealth legislation to create stand-alone bills. This may be because members want "to create certain visibility for certain legislation and maybe for themselves," he added. -- Ariel Cohen
