This year marked the start of a new Administration and the 115th Congress with Republicans now in control of both branches of government. Just over a month into the new session of Congress, the legislative agenda is still being determined as Congress awaits input from the White House on key issues.
At this time, it is not clear what will happen with telehealth legislation this year, even though our lobbyists have met with key Congressional leaders and staff who are involved in the process. There has been some indication from staff that they want to shift their approach in this area in response to cost and other concerns that surround telehealth. Because of this, we are modifying the AARC legislative agenda for 2017. As we learn more in the coming weeks, the strategy could be revised prior to our PACT Hill Day on April 4.
There will be a two-prong approach to our advocacy efforts as follows:
- Include respiratory therapists as telehealth providers in any telehealth legislation introduced this year to ensure that Medicare beneficiaries with chronic respiratory disease have access to their expertise.
- Include language in the FY 2018 Labor-HHS Appropriations Report asking CMS to conduct a data analysis of COPD claims in various health care settings that will show how respiratory therapists improve health outcomes, reduce hospital readmissions and lower costs.
Frequently Asked Questions
Are we still going to ask for co-sponsorship of the Medicare Telehealth Parity Act?
The answer is “It depends.” At this time, the Medicare Telehealth Parity Act has not been reintroduced. From contacts with Cong. Mike Thompson’s office, the legislation’s author, we do not know if the bill language will be the same as last year or whether the legislative text will be revised. All indications are that respiratory therapists or respiratory services will be part of the new legislation regardless of the form it takes. If the bill is reintroduced prior to our Hill Day, or if we have more information that would make it feasible to ask for co-sponsorship or a companion bill in the Senate, PACT representatives will be advised through the listserv and the FAQs will be revised accordingly.
Do we lose any impact we gained last year because we are not asking for co-sponsorship of a particular bill?
No, there is absolutely no downside to not requesting sponsorship of a specific bill. In fact, by making the request broader to ensure that RTs are included in any telehealth legislation introduced this year, we expand our impact.
What Do I Need to Know about Other Telehealth Legislation?
As telehealth has become an integral part of the delivery of health care today, there were a number of telehealth bills introduced in the last Congress. However, as noted above, because it is still early in the Congressional session, we are not able to predict with certainty when and what action will be taken on telehealth. We will be keeping track of the CONNECT for Health Act, which was a topic of discussion on the Hill last year, and the CHRONIC Care Act, a bill that was introduced in early December 2016. The latter is not considered a “telehealth bill”, although it does have provisions for expansion of telehealth services in Accountable Care Organizations and Medicare Advantage plans and was introduced by the Senate Finance Committee Chronic Care Working Group members.
A new bill introduced this year would expand telehealth services as part of a pilot program for Medicare individuals living in public housing located in health professional shortage areas. It includes respiratory therapists and respiratory care as a covered telehealth service similar to the Parity Act. However, unlike the Parity Act, the bill has a single Democratic sponsor. Without bi-partisan support in a Republican-controlled Congress, it is unlikely the bill will move forward. As we learn more, PACT representatives will be kept advised.
Why is it important to ask that language be included in the FY 2018 Labor-HHS Appropriations Report?
Each year, Congress is required to pass appropriations bills to fund the Government. Each bill is accompanied by a report that directs the agencies to report back or take certain actions. We want Congressional Members to include a request that asks CMS to conduct a data analysis of COPD claims in various health care settings that will show how respiratory therapists improve healthoutcomes, reduce hospital readmissions and lower costs.
We believe this approach is necessary to demonstrate the clinical value RTs bring to improving the care provided to their patients. A report from CMS will go a long way to validating respiratory therapists’ unique skills and expertise. We focused on COPD because it is the third leading cause of death and the fourth most costly condition with respect to hospital readmissions. Also, it is less complicated to get language added to an appropriations report than passing a standalone bill, so this could be a big “win” for the profession.
What are the difference between telehealth, remote patient monitoring and store and forward technologies so I have a better of idea of how they work?
Telehealth is an interactive audio and video telecommunications system which allows real-time face-to-face communication between physicians and other health care providers and their patients located at different sites. For example, the beneficiary may be physically located in a rural health clinic or a skilled nursing facility while the physician is in his/her office suite or the hospital. The term “telemedicine” is often used interchangeably with “telehealth.”
Remote patient monitoring is conducted via a coordinated system that uses one or more home- based or mobile monitoring devices that automatically transmit vital sign data or other information as part of a patient’s plan of care wirelessly, or through a telecommunications connection to a server, allowing review and interpretation of that data by a health care professional.
Store-and-Forward Telehealth involves the acquisition and storing of clinical information (e.g. data, image, sound, video) that is then forwarded to (or retrieved by) another site for clinical evaluation (e.g., analogous to sending a picture via text message). For Medicare, this means the information would be transmitted from the originating site where the beneficiary is located to the distant site where the physician/practitioner is located for review at a later date.
What Does Medicare Cover Currently with Respect to Telehealth Services?
Current Medicare coverage of telehealth services is limited to rural counties and health shortage areas in metropolitan fringes with the patient at a health facility (known as “originating sites”). Originating sites include physician offices, hospitals, skilled nursing facilities, and rural health clinics. Practitioners who can provide telehealth services currently include physicians, nurse practitioners, physician assistants, nurse-midwives, clinical nurse specialists, clinical psychologists, clinical social workers, and registered dietitians or nutrition professionals. Only a select number of medical procedures/services are covered such as consultations, counseling services, education, patient assessments, smoking cessation and transitional care management services.