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Growth of Telehealth May Hinge on Government Commitment

By Kerry Young, CQ HealthBeat Associate Editor

July 29, 2014 -- Doctors, researchers, and officials at companies such as Humana Inc. are tinkering with ideas for expanding the use of remote medical visits and services, but the true driver for expansion of telehealth likely will be the nation's biggest purchaser of health care.

For now, the Centers for Medicare and Medicaid Services (CMS) is taking a "rather cautious" approach in its payment policies for remote services and monitoring, Megan McHugh, a health researcher from Northwestern University, told a House panel last week.

That's justified given that the evidence for benefits has not been conclusive, she said. Remote medical consultation and monitoring have been hailed by many advocates as potential game-changers that could cut costs and help people better manage chronic illnesses, such as diabetes.

Yet, studies so far have drawn opposing conclusions about the benefits, McHugh said. She cited a compilation of 20 reviews that found telemedicine effective, while 22 others found it to be of limited benefit or ineffective. Another 19 were less confident of the benefits, but did note its potential.

"The gradual expansion of telemedicine coverage under Medicare is a sensible course of action and one that will produce a slow but steady increase in the number of small practices that effectively and efficiently use telemedicine," McHugh told the House Small Business Committee's panel on health and technology.

Medicare's decisions ripple beyond even the pool of roughly 50 million people covered by the program for the elderly and disabled. They are "magnified" because insurance companies often look to CMS decisions in setting their own policies, McHugh said. Through its rulemaking process, CMS has expanded somewhat the field of doctors and patients for which it will pay for telehealth, she said.

For 2014, CMS has somewhat widened the geographic limits that had been earlier written to restrict payments for the services to cases where people faced long trips to see a doctor. By allowing telemedicine payments for some parts of the metropolitan statistical areas, CMS has made services reimbursable for about 1 million more people enrolled in Medicare.

There's clearly a drive among some lawmakers to get CMS to take a more expansive approach, even as small-scale experiments take place around the country that may make clear both the advantages and shortcomings of the technology.

Sen. Thad Cochran, R-Miss., this month introduced a bill (S 2662) that's intended to waive certain Medicare restrictions on telehealth. It's a companion measure to a bill (HR 3306) from Rep. Gregg Harper, R-Miss., which has about 20 cosponsors. The American Telehealth Association, which includes companies such as Humana and Dutch technology company Philips, supports the measure.

Smaller-scale efforts underway include a Humana program intended to help elderly people remain in their homes longer by protecting against falls and other health threats.

Humana in December said about 100 people in its Medicare Advantage programs had enrolled in the pilot program intended to use remote monitoring to help frail elderly people continue living in their own homes. The project involves in-home sensors and remote monitoring that will report changes in normal patterns of movement to Humana care managers. The sensors will check on daily activities such as sleeping and eating. Changes in patterns for these activities can be early warning signs of illness, and detecting them may allow Humana workers to step in earlier to offer aid, the company said.

In testimony for the hearing last week, McHugh said that dermatologists at Kaiser Permanente in San Diego were able to handle 50 percent more cases through a remote teleheath system, in which patients' history and images of skin lesions were made available to them, than they would have been able to handle in face-to-face visits.

The question of licensing across states for telehealth services also arose at the hearing. Chris Collins, R-N.Y., the chairman of House Small Business' health and technology panel, asked whether some exceptions to federal rules might be needed to allow doctors to get reimbursed for seeing their own patients via telehealth when they are far from home.

"I am from western New York and we have a lot of folks in our older population who go south for three months to Florida," he said. "It's not a New York doctor poaching in the Florida area for clients but an existing client relationship."

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