Proponents of exploring the impact of expanded access to telemedicine services within the Medicare program received a big boost from Sen. Brian Schatz (D-Hawaii) Feb. 3 when he introduced the Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act. This bipartisan bill seeks to, among other things, eliminate existing restrictions on telehealth services within narrowly targeted physician-developed “bridge demonstration projects,” as well as Alternative Payment Models (APMs). Senators Thad Cochran (R-Miss.), Roger Wicker (R-Miss.), John Thune (R-S.D.), Ben Cardin (D-Md.), and Mark Warner (D-Va.) are original cosponsors of the legislation. Reps. Diane Black (R-Tenn.) and Peter Welch (D-Vt.) are expected to introduce an identical companion bill in the House of Representatives.
Telehealth is broadly defined as the use of telecommunications technologies to deliver health care, health information or health education at a distance. Technological innovations for telehealth are evolving quickly and can now incorporate such disparate uses as patient office visits via video conferencing, remote patient monitoring and medical imaging store-and-forward capabilities.
Existing laws and regulations restrict telehealth services offered by physicians to a select category of “originating sites” primarily in rural areas. Many rural state senators, as well as some telecommunications and health care companies, feel the current system is antiquated, stifles innovation, restricts competition among physicians, and even denies access to quality health care to some patients.
With the exception of current state licensure laws, the CONNECT for Health Act would enable the Secretary of Health and Human Services (HHS) to waive all other existing restrictions on telehealth services provided within physician-developed demonstration projects. Physicians who obtain such waivers must still provide health care services in a manner consistent with the Merit-Based Incentive Payment System (MIPS), specifically in regard to quality, resource utilization and clinical practice improvement.
Created through Medicare and CHIP Reauthorization Act of 2015, bipartisan legislation which repealed the flawed Sustainable Growth Rate (SGR) formula, the MIPS program is a modified fee-for-service system which physicians have the option of participating in starting in 2019. Participating providers will be subject to random HHS telemedicine performance audits. Waivers on existing restrictions are scheduled to expire on Dec. 31, 2019. Afterwards, the Centers for Medicare and Medicaid Services (CMS) will be required to produce a report to Congress on the impact of the modified telehealth program on Medicare spending and patient care. Supporters of expanded telehealth services hope a positive report will prompt Congress to pass legislation that would permanently remove the current restrictions.
If adopted, the CONNECT for Health Act would also permanently remove all existing telehealth regulations applicable to APMs on Jan. 1, 2017. State licensure laws, however, would also still apply for providers participating in APMs.
To date, the American Medical Association, American Telemedicine Association, Alliance for Connected Care, Third Way (a think tank/lobbying group) and ACT: The App Association (an organization that represents mobile app software developers) have formally endorsed the CONNECT for Health Act.
While the government relations office continues to review the bill, the American College of Radiology’s (ACR) physician leadership is concerned that the bill may undermine quality patient care while simultaneously accelerating efforts to commoditize the specialty of radiology. The ACR, however, appreciates that the CONNECT for Health Act does not propose to alter the existing system of state physician licensure for telehealth.
ACR members are encouraged to monitor the Advocacy in Action newsletter for additional information on telemedicine.