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Apr 29 2011   10:27AM GMT

ATA: Continuing to limit telehealth services a barrier to ACO model



Posted by: Beastwood
accountable care organizations, ATA, medical home model, telehealth services, telemedicine

As researchers, physicians and vendors gear up for the American Telemedicine Association’s ATA 2011International Meeting & Exposition, the organization is making it quite clear that, for accountable care organizations (ACOs) to progress, restrictions on telehealth services must be lifted.

In an April 25 letter to Dr. Donald Berwick, administrator for the Centers for Medicare & Medicaid Services (CMS), the ATA effectively issued a response to the proposed ACO rule. The organization pointed to five provisions of Social Security Act section 1834 that, by restricting telehealth services, contain “major, arbitrary barriers to accountable care organizations,” especially given the financial limits they will face.

Existing restrictions prohibit the following:

  • Health service by video conferencing.
  • Store-and-forward services for Medicare beneficiaries in the continental United States.
  • Medicare reimbursement for specific clinical tests and evaluations conducted using telehealth services.
  • Reimbursement for telehealth services that originate in a Medicare beneficiary’s home, a hospice or even certain federally funded facilities.
  • The use of telehealth services for physical therapy, occupational therapy, pathology and audiology.

Keeping the restrictions in place amounts to an endorsement of hypocrisy, the ATA hinted.

  • The proposed ACO rule encourages the organizations to “draw upon the best, most advanced models of care, using modern technologies…to continually reinvent care in the modern age.”
  • Existing guidelines govern the use of store-and-forward telehealth services in numerous federal departments, including Indian Health Services and the Department of Veterans Affairs.
  • Telehealth services are fundamental to the expansion of the medical home model. This model is central to both the ACO program as well as health care reform, as it helps provide care to homebound patients.

A recent Cisco Systems Inc. survey of government health officials around the world pointed to an opportunity gap for telehealth services, with U.S. adoption slowed because of a lack of funding, successful large-scale pilot projects and, above all, insurance reimbursement.

The ATA, for its part, has advocated payment reform for years. Perhaps linking that to the hot-button issue of making accountable care organizations succeed will bring about the change that telehealth services need to finally catch on.

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