CMS ought to accumulate residence well being telehealth information, consultants say

The Facilities for Medicare and Medicare Companies ought to accumulate information about telehealth use in residence well being to information policymakers in setting reimbursement charges for suppliers, consultants mentioned through the Medicare Fee Advisory Fee’s September assembly on Friday.

CMS adjusted how the Medicare program pays suppliers below the house well being potential cost system in 2020 after Congress mandated adjustments to these funds within the Bipartisan Price range Act of 2018. Beneath the Affected person-Pushed Groupings Mannequin, CMS moved from a 60- to 30-day cost unit and stopped basing funds on the variety of remedy visits to curb their use.

MedPAC tried to look at the influence of these adjustments on residence well being, discovering a 20% decline in in-person visits final 12 months. The drop in in-person visits could have stemmed from the cost system not encouraging further visits, based on a MedPAC evaluation. Nevertheless it’s unclear whether or not cost adjustments or the pandemic contributed extra to the discount.

“I am not prepared to attract a conclusion but,” MedPAC Chairman Michael Chernew mentioned.

CMS’ lack of knowledge on telehealth use in residence well being complicates issues as a result of the company and MedPAC cannot decide whether or not Medicare beneficiaries went with out help or accessed assist by way of telehealth as an alternative.

“It is arduous to know what is going on on with out understanding in regards to the telehealth visits,” MedPAC commissioner Dr. Lawrence Casalino mentioned.

It is possible a mixture of each, however no actual figures can be found, making it difficult to measure residence well being utilization. In accordance with a MedPAC survey, 71% of residence well being companies elevated telehealth choices final 12 months. If MedPAC might have included telehealth visits in its evaluation, the measured lower in residence well being utilization most likely would have been smaller final 12 months, panel workers mentioned.

Not solely would accumulating information on telehealth use in residence well being make it simpler to find out whether or not CMS set funds accurately, it will additionally provide higher perception into the standard.

“There are some providers that it looks as if you might do fairly effectively over telehealth and others that possibly not as a lot,” MedPAC commissioner Stacie Dusetzina mentioned.

MedPAC will not suggest that CMS require residence well being suppliers to report their telehealth use, however the fee could describe the advantages of such a requirement in its March 2022 eport.

A current CMS evaluation discovered that base funds below the brand new mannequin had been 34% above common prices in 2020, although the company had accounted for supplier upcoding when it set the charges. Suppliers objected to CMS’ methodology and threatened to sue if CMS tries to claw again overpayments.

“That is actually disappointing,” MedPAC commissioner David Grabowski mentioned. “I assumed this mannequin would transfer us nearer to right-sizing or encouraging high-value care. And it looks as if possibly this can be a step within the flawed route.”

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