Telehealth plays a promising role in value-based care, with the potential to offer high-quality care without increasing cost, the Centers for Medicare and Medicaid Services said in a November 15 report to Congress required under the 21st Century Cures Act.
But its use by Medicare beneficiaries is still limited. CMS found that from 2014 to 2016, the overall rate of telehealth adoption increased, but only one quarter of one percent in 2016 took advantage of the service.
Close to 90,000 Medicare patients used 275,199 telehealth services, representing .25 percent of the more than 35 million total Medicare beneficiaries, CMS said.
Among the biggest barrier to adoption is current law, as the use of telehealth in traditional Medicare currently is limited to the originating site of provider service in a rural geographic area and for certain conditions.
WHY THIS MATTERS
Telehealth has the potential to improve access to care.
It offers the promise of technology to care for a broad range of populations, providing high-quality care without increasing costs, CMS said.
Medicare Advantage plans already have the ability to offer additional telehealth services, such as remote access technology, as a supplemental benefit.
MA plans may also allow a provider to diagnose and treat some conditions by telephone, or by real time interactive audio and video.
In addition, the Bipartisan Budget Act of 2018 will allow MA plans, starting in 2020, to provide additional telehealth benefits. The proposed rule would allow for telehealth services from a patient's home.
Medicare pays for remote patient monitoring in home health services.
Under certain payment models, CMS waives the rule of using telehealth only from an originating rural site. Current models with telehealth waivers include Next Generation, Bundled Payments for Care Improvement Initiative and Comprehensive Care for Joint Replacement model.
Where telehealth has shown significant growth is with beneficiaries who are 85 and older. A majority who used the telehealth service, 85.4 percent, had at least one mental health diagnosis. Psychotherapy is among the services most commonly used.
The data suggests that the use of telehealth is concentrated in rural areas, with the ten highest being Texas, Iowa, California, Missouri, Michigan, Minnesota, Wisconsin, Georgia, Virginia and Kentucky.
The top diagnoses for Medicare beneficiaries receiving telehealth services in 2016 were for depression, bipolar disorder, schizophrenia, anxiety, reaction to severe stress, sleep disorders, cerebral infarction, and Alzheimer's disease.
Telehealth would be useful in an expansion to urban areas and as a service for opioid treatment program access.
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