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Warner Sees Medicare Telehealth Bill Defying Election-Year Odds

By Kerry Young, CQ Roll Call

February 3, 2016 -- Sen. Mark Warner said a strong bipartisan coalition of lawmakers from both chambers could succeed in clearing legislation to expand Medicare payments for telehealth services, even with the November presidential contest expected to limit the number of laws enacted this year.

"I know this an election year and there is a general consensus that we are not supposed to get stuff done," the Virginia Democrat said Wednesday at a press conference as he and Brian Schatz, D-Hawaii, introduced a bill regarding health care provided by phone or computer. "At least on the question of telehealth, we are going to prove them wrong."

The new bill arrives with the strong backing of the American Medical Association, which argues that the measure could save $1.8 billion over a decade. It would waive in certain cases a requirement set by federal law that to date has largely limited Medicare payments for telehealth services to cases where people live in rural areas and thus may have great difficulty in reaching medical offices. This requirement, along with some doubts about the effectiveness of some uses of telehealth, led federal officials to reject previous bids to expand payments through the annual updates of Medicare's payment rules for doctors' services.

The bill would seek to use health consultations provided at a distance to aid with a massive shift underway in how Medicare pays doctors. Last year's overhaul of physician reimbursement (PL 114-10) will tie these payments to judgments about the quality of care delivered. Schatz's measure would expand the use of remote patient monitoring for certain patients with chronic conditions as part of an effort to help doctors meet the goals set by the law.

The new bill already is supported by conservatives Roger Wicker of Mississippi and John Thune of South Dakota and liberal Democrat Sen. Benjamin L. Cardin of Maryland.  A similar coalition exists in the House for the companion measure, uniting Rep. Peter Welch of Vermont with Republicans Diane Black of Tennessee and Gregg Harper of Mississippi.

Another key supporter is Senate Appropriations Chairman Thad Cochran, a Republican. His home state of Mississippi is something of a surprising leader in the field of telehealth. Mississippi laws mandating coverage of care provided at a distance has won the state, often a laggard on some other health care measures, top marks from the nonprofit American Telemedicine Association. High rates of obesity and diabetes led the University of Mississippi in 2014 to partner with General Electric and Intel Corp. units to offer access to medical staff through telemedicine for people combating chronic ailments. The approach is a boon for a state where medical care is often hard to find, Cochran said Wednesday.

"In states like mine, when you wanted to go to the doctor, you sometimes went to Memphis or New Orleans," Cochran said at the press conference, which was held in an Appropriations Committee hearing room.

As the top Senate appropriator, Cochran said he would make sure that the future spending for telehealth programs would be "as generous as possible." The fiscal 2016 spending package (PL 114-113) boosted funds for rural telehealth program by $2.1 million to $17 million within the Health Resources and Services Administration. Appropriators also directed the Department of Health and Human Services to move increase cooperation among federal agencies and demanded a report in mid-2016 with recommendations on these efforts.

But the main target for expanding use of telehealth services is Medicare, which pays about $600 billion a year for medical care for the nation's elderly and disabled people. Medicare falls under the jurisdiction of the Senate Finance Committee.
A likely eventual vehicle for the provisions in Schatz's measure may be a separate Senate Finance Committee bill being written to improve the care of people suffering from chronic conditions such as diabetes. Warner is working with Sen. Johnny Isakson, R-Ga., and other Finance members leading this chronic care effort. Two other backers of Schatz's bill, Thune and Cardin, also serve on Senate Finance.

The Centers for Medicare and Medicaid Services (CMS) has been wrestling with ways to expand teleheath services while sticking within the current confines of federal law and also making sure there is adequate evidence of a benefit for certain uses of remote access to health professionals.

CMS last year expanded the use of telehealth for cases where people undergo kidney dialysis at home. The change was in the 2016 payment rule for physicians. In that regulation, CMS rejected a bid to expand telehealth payments for pain management and palliative services for cancer patients, citing in part a lack of "evidence of clinical benefit." 

The CMS $10 billion Innovation Center, established in the health law in part to test alternative approaches to payment, has provided another path for expansion of telehealth services. One of its marquee programs, the Next-Generation Accountable Care Organization model, includes coverage of telehealth.

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