Reimbursement for home monitoring gradually expands

By: Neil Versel | Sep 26, 2013        

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Neil_Versel_LargeBarriers to reimbursement for telehealth services are falling, slowly.

One of the most recent victories came in Massachusetts, where lawmakers this summer approved a general appropriations bill that included Medicaid reimbursement for remote monitoring services in patient homes. This action, passed over a veto by Gov. Deval Patrick, makes Massachusetts the 12th state to approve Medicaid payments for home monitoring, according to the American Telemedicine Association.

The ATA reports that 19 states have mandated private insurance coverage for traditional, clinician-to-clinician telemedicine services, but reimbursement for home monitoring when a healthcare professional is not always present has been much harder to come by.

In fact, the Massachusetts legislation has a bit of a catch: it applies only to home health agencies, not hospitals or physician practices, which is why the Massachusetts Medical Association declined to comment. The Home Care Alliance of Massachusetts, however, was ecstatic.

“This is a huge deal for us,” James Fuccione, director of legislative and public affairs with Home Care Alliance, representing home care agencies in the Bay State, told MobiHealthNews. “It’s been one of our main priorities, getting MassHealth reimbursement for telehealth.”

MassHealth encompasses the federally funded but state-administered Medicaid and Children’s Health Insurance Program (CHIP) in Massachusetts.

“This isn’t just the future,” Fuccione continued. “Telehealth is happening, and it has been for a while.”

Medicaid, of course, covers some of the sickest, most vulnerable populations in every state, and the Massachusetts appropriations bill made clear that lawmakers there see coverage for remote patient monitoring as a way to save money by investing in better care. “[F]or purposes of long-term health care cost savings and enhanced patient care, the commonwealth shall recognize telehealth remote patient monitoring provided by home health agencies as a service to clients otherwise reimbursable through Medicaid,” the legislation said.

The idea, according to Fuccione, is to keep people out of the hospital and to prevent post-discharge readmissions by having home health agencies intervene at the first sign of a problem. “It’s about [providing] the best care at the appropriate time,” Fuccione said.

A lot of work remains to be done, though. MassCare needs to set reimbursement rates for home telehealth and establish a payment infrastructure before Medicaid providers can start billing.

And then there’s the little issue of the 38 other states that don’t pay for home monitoring through their own Medicaid programs. Some – perhaps most of them – will claim poverty as they often do when it comes to covering new services, but I have a feeling the efficiency and safety benefits of remote patient monitoring are starting to become more apparent to all but the staunchest defenders of the status quo.

A decade and a half ago, health IT advocates worked state-by-state to get e-prescribing legalized nationwide, as it is today. It looks like a similar movement for home monitoring is picking up steam.

  • François Recorbet

    This is great news!

  • Rob McCray

    Neil – there is some hope that before your 15-year horizon ends most health care financing will be move to an outcomes rather than transaction based model.

  • Neil Versel

    15-year horizon?

  • Rob McCray

    Referencing your last paragraph. Of course, if our DC representatives do not get their act together the transition to a more rational set of financial rewards for providers may be accelerated by the market or go even more slowly in a gridlocked, politically controlled CMS.

  • Neil Versel

    I didn’t say it would take 15 years. I said it was a decade and a half ago that the movement to legalize e-prescribing was taking place. I suspect this will be widespread in 5 years.

  • Rob McCray

    Sorry for the misinterpretation. I like your reference, though you may agree that the challenges to telemedicine are larger than than those that faced e-prescribing. E-prescribing required work flow changes, but did not replace or add reimbursed services nor require major changes in state law. Telemedicine faces reimbursement and regulatory challenges. Under the dominant fee for service model, reimbursement for “barrier-free” telemedicine will be a concern for CMS and other payors. Also, an efficient approach to obtaining the full benefits of telemedicine will require a federal override of state licensure laws or state-by-state changes. ATA is the key sponsor of legislation in this area, and is also a resource for how to get along under the current system. My belief and hope is that we will move to a more rational financial model for health care which will help eliminate some of the financially based opposition that connected health innovation faces.

  • Kevin McMahon

    Neil, regarding your 5 yr prediction in reply to Rob’s comment… granted a lot has changed in the past 5 years but if I go back to October 2008 and predict the status of reimbursement in October 2013, real reimbursement and adoption have barely moved if at all. Also, as a tax payer, I do not like reimbursement for telehealth delivery as it is ripe for abuse. I’d much rather see reimbursement for outcomes (which depend on how telehealth is used; program and technology design) or at a minimum incorporating some sort of demonstrated utilization caveat based on readily available and verifiable data inherent in telehealth.

  • NeilVersel

    Kevin, good points all. I’m thinking it will accelerate in the next couple of years if accountable care takes hold, and reimbursement will increasingly be part of bundled payments. There’s always chance of abuse and someone will always try to game the system, but shifting the incentives should at least mitigate the desire to rip off not only taxpayers, but also purchasers of private insurance.