Digital Health: New Law Encourages Telehealth Services For Medicare Patients
By Nancy Bradish Myers
As Congress moved to keep the doors open for the federal government, it also swept in changes to advance the use of telemedicine for Medicare patients.
These are exciting changes that will improve the patient experience by making health care delivery more convenient and efficient. This is also good news for both large and small digital health companies.
If you’re in the digital health space, it’s important to note that in the past, Medicare has only permitted telehealth services to be provided in physician offices, hospitals, rural health clinics and other types of health care facilities. Under the new law to keep the government open (HR 1892), signed into law by President Trump on Feb. 9, patients now have the option of receiving telehealth services in their own homes.
I see three main improvements for Medicare patients that also bring opportunities for digital health companies:
- Allows Medicare Advantage plans to offer “additional” telehealth services under Medicare Part B (outpatient/physician office care).
- It will be up to the HHS Secretary (likely via CMS) to solicit public input on what these additional services may entail.
- For example, by Nov. 30 of this year, the Secretary will solicit public input on what types of items and services, “such as remote patient monitoring, secure messaging, store and forward technologies, and other non-face-to-face communication” should be considered.
- Allows accountable care organizations (ACOs) to expand use of telehealth:
- For a Medicare fee for service beneficiary assigned to an ACO, starting in 2020: Requires that the patient’s home be treated as an “originating site,” thus expanding allowable sites for telehealth to move beyond traditional sites.
- HHS is required to conduct a study and issue a report by Jan. 1, 2026 on implementation of this section, to include an analysis of utilization and spending on telehealth, along with recommendations on any needed changes, either via legislation or administrative action.
- Provides for use of telehealth services for stroke patients:
- Given the time-sensitive nature of responding to stroke patients, this provision expands the definition of “originating site”to include any hospital, critical access hospital, mobile stroke unit, or any other site HHS deems appropriate at which the patient is located at the time the telehealth service is provided.
The law also includes provisions allowing use of telehealth for home dialysis patients.
Here are the key opportunities we see for digital health companies:
- There will be opportunities for public input into what constitutes “additional telehealth benefits” under Medicare Advantage plans.
- This provides companies, patient advocates and other stakeholders to comment on specific technologies that should be included.
- The examples noted in the law — such as “remote patient monitoring, secure messaging, store and forward technologies and other non-face-to-face communication” – are broad and thus may open the door for a rather inclusive approach to defining what types of technologies may qualify as “telehealth.”
- In general, we think this language is positive for anyone who has a technology that allows for the collection of data in the home and transmission of that data to a physician.
Bottom line: Congress clearly wants CMS to expand the availability of Medicare telehealth services and make them available in non-clinical settings such as the patient’s home.
Next steps: Companies with digital health technologies that could potentially help Medicare patients receive telehealth services in their homes should consider submitting comments to HHS/CMS on implementation of these telehealth provisions. This opportunity to comment may come up soon, but at the latest, it will occur before Nov. 30 – so now is a good time to begin thinking through the options for providing input on HHS’ approach to expanding use of telehealth services.