Progress in Medicare Reimbursement for Telehealth and New Primary Care Model

Guest post by Dr. Deborah A. Jeffries, director of sales, Revolve Robotics.

Dr. Deb Jeffries
Dr. Deb Jeffries

There are exciting developments with telehealth reimbursement thanks to the progress in moving towards Patient Centered Care, and a focus on Prevention and Wellness. Early in 2016 we saw the introduction of Senate bill 2484 and with it a proposed path to remove many of the obstacles to providing access to patient centered care and telehealth. Now we are seeing the Comprehensive Primary Care Plus model take shape that further supports telehealth adoption and reimbursements. Imagine a connected care team, in collaboration with patient and family members, the relevant data is available as needed, and an empowered healthcare provider who is able to ‘do the right thing’ with respect to each patient.

Wouldn’t it be great if care was accessible independent of the patient’s or doctor’s location, whether they are rural or urban, whether they are in their home or in a clinic? Well, Senate bill 2484 may do just that. It is looking at removing obstacles to delivering telehealth services and opening the door to the delivery of care where and when it is needed.

Additionally, wouldn’t it be great if the primary care practitioner were free to utilize the right delivery of care at the right time?

To date it has been difficult to find a model that empowers the primary care provider and provides the freedom to do what they know is best for their patients including telehealth as appropriate. This year, a change is kicking off that may go a long way toward enabling the primary care practitioner. It comes in the form of the recent announcement from CMS in an interview with Joyce Freidon from Medpage Today published in article on 4-11-16: “The 5-year initiative, known as the Comprehensive Primary Care Plus model, will give doctors the freedom and flexibility to practice medicine the best way they know how, to return to what matters most to doctors and their patients,” said Patrick Conway, MD, CMS chief medical officer, on a phone call with reporters.

And Dr. Conway states “If telehealth makes sense, they can do that.” As the program kicks off this summer and goes into action January 2017, look for more details to unfold.

The article further quotes Dr. Patrick Conway:
“Doctors will be given more freedom to design the type and amount of care that best meets the needs of their patients,” said Conway. “If telehealth makes sense, they can do that … This initiative will also make it easier for doctors to communicate with each other and have all the information they need … to get better support from nurses, specialists, and others on the patient’s care team.”

A complete description of the new Comprehensive Primary Care Plus program can be found at: https://innovation.cms.gov/initiatives/comprehensive-primary-care-plus and a fact sheet is available at https://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2016-Fact-sheets-items/2016-04-11.html

As healthcare initiatives move to improve patient access and outcomes, technologies that improve the patient experience are being brought into the equation. We are seeing healthcare technologies become more mobile and at a lower price point to support the evolving model of low cost accessible connectivity enabling a true patient centered model of care.

Over the last several years we have seen many changes as we move to Patient Centered Care, not the least of which were the introduction of financial penalties for unnecessary re-hospitalizations, and efforts to make patient data accessible to the care team. This year and next promises to be exciting as we follow the Senate bill and the new primary care model. It will be interesting to see what it means to the future of healthcare and telehealth/telemedicine, and the ability to do the right thing.

Thanks for reading and we’ll be sure to keep you updated as we learn more.

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