Telehealth in October continued to make the news, as CMS issued new reimbursement guidelines expanding the use of telemedicine for home health and other clinical providers. CMS also proposed expanding reimbursement under Medicare Advantage plans.
On the for-profit side of care delivery, computer innovator Apple launched a new mHealth study using the Apple Watch and a new digital health app to remotely monitor and provide care coordination for knee or hip surgery patients.
Finally, the Most Wired survey prominently featured telehealth as a service used by 89% of hospitals – and growing
October was a busy month in the telehealth field. Here’s what happened.
CMS Reimbursing for Telehealth
Big news at the end of October; the Centers for Medicare & Medicaid Services (CMS) released their final 2019 Physician Fee Schedule and Quality Payment Program. In it, they opened the door a little wider for reimbursement for telehealth’s connected care delivery models. CMS said, “This is an historic change in terms of increasing access and it’s also a great example of some of the effort that we’ve been trying to make around supporting innovation.”
The new payment rules particularly emphasize reimbursement for remote monitoring of patient health, particularly in the area of chronic disease management. Some of the Fee Schedule changes include:
- CPT 99453 a new remote monitoring code of physiologic parameters like blood pressure, pulse oximetry, respiratory flow, and weight. The code also reimburses for equipment set-up and patient education.
- CPT 99454 covers the transmission of recordings of physiologic data such as blood pressure, pulse oximetry, respiratory flow, and weight.
- CPT 99457 is another physiologic remote monitoring code for “treatment management services” of interactive communication between patient and caregiver of 20-minutes or more.
The new ruling did not specify what type of software or hardware could delivery this data, whether smartphone apps, desktop, Holter-Monitors, Fitbits, or other technology.
The new ruling also eliminated geographic restrictions for telehealth used in the treatment of a substance use disorder or a co-occurring mental health condition. While these rules won’t kick in until July 2019, they also would make the patient's home an originating site. This is particularly important due to the stigma around substance abuse issues; advocates suggest that this might encourage more people to stay in treatment longer.
Home health agencies also benefit from the latest reimbursement changes; CMS will no longer require these providers to prove medical necessity for a home visit in place of a traditional office visit. This would allow these agencies to potentially use remote patient monitoring or a virtual visit. In a press release, CMS said, “Studies note that remote patient monitoring has a positive impact on patients as it allows patients to share more live-time data with their providers and caregivers, which will lead to more tailored care and better health outcomes.”
CMS Proposes Expanding Telehealth in Medicare Advantage
Also at the end of October, CMS published their plans to expand telehealth within Medicare Advantage plans. The proposal seeks to eliminate the geography restrictions in Medicare Advantage plans by 2020. It would eliminate originating site restrictions and seek to broaden the volume of treatment offered via telehealth by expanding reimbursement.
Originally, Medicare had narrow location categories for what was reimbursable under the plan. Under the new rule, Medicare Advantage would reimburse for telehealth visits in the patient’s home. CMS anticipates these changes would be part of a $4.5 billion cost savings benefiting the agency and taxpayers over the next 10 years.
These recommended changes will be published in the Federal Register on November 1 and will be open for public comment through the end of 2018.
Apple Launches mHealth for Ortho Surgery Patients
Can the Apple Watch, coupled with a new phone app, help hip and knee surgery patients by providing home monitoring and care coordination? That’s the premise of a massive study launched last month that seeks to connect orthopedic teams and patients both before and after surgical intervention.
The Apple Watch features a new app called mymobility that sends daily surveys, medication reminders, and PT instruction after surgery. Patients can respond back to their care teams, providing them with daily progress reports. This immediate real-time connectivity allows caregivers to shift treatment plans in between on-site appointments.
The goal of the pilot program is to increase patient engagement by “giving them the ability to use their health and activity information to improve their own care.” The goal of the study is to enroll 10,000 patients. Given that mHealth Intelligence reports there are currently one million knee or hip surgeries annually and the number will leap to 3.5 million by 2035, it’s clear that Apple has its eye set on moving further into the wearable device market. Given that CMS is making moves to improve reimbursement for remote health monitoring, it is expected that more healthcare providers will seek out remote health monitoring tools to improve the health of populations while cutting costs.
Clinical participants in the study include academic health systems like Emory, hospitals including Partners HealthCare Newton-Wellesley Hospital, and even group practices and ambulatory surgery centers around the country.
Most Wired Survey Features Telehealth
The 2018 Most Wired survey of more than 600 hospital c-suite was just released and it’s no surprise that telehealth was mentioned prominently in the report. The survey this year linked telehealth with patient engagement, a hot-button issue, especially within population health circles. The survey noted 89% of all hospitals use telehealth but patients are still learning about the benefits of these tools. Hospitals, too, “are still early in their telehealth journey” and have failed to reap the full benefits of the technology because “they’re still trying to navigate their way from a fee-for-service model” to value-based care. Most Wired reported, however, concluded:
The progress of virtual care may indicate that the industry is approaching around-the-clock connectivity as telehealth enables clinicians to provide more direct, more accessible care.
OrthoLive for Connected Virtual Care
OrthoLive continues to improve our partnerships with orthopedic providers interested in the virtual house call. Our application is live and we’re standing by to share how it can benefit your practice. Contact us to find out more.