By Nancy Bradish Myers
As Congress moved to keep the doors open for the federal government, it alsoÂ 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 youâ€™re in the digital health space, itâ€™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 newÂ lawÂ 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 seeÂ three main improvementsÂ for Medicare patients that also bring opportunities for digital health companies:
- Allows Medicare Advantage plans to offer â€śadditionalâ€ť telehealth servicesÂ under Medicare Part BÂ (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,Â the Secretary will solicit public input on what types of items and services, â€śsuch asÂ remote patient monitoring, secure messaging, store and forward technologies,Â andÂ other non-face-to-face communicationâ€ť 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 patientâ€™s home be treated as an â€śoriginating site,â€ť 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 â€śoriginating siteâ€ťto includeÂ 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 forÂ homeÂ dialysisÂ patients.
Here are the key opportunities we see for digital health companies:
- There will be opportunities for public input into what constitutes â€śadditional telehealth benefitsâ€ť 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 —Â such as â€śremote patient monitoring, secure messaging, store and forward technologies and other non-face-to-face communicationâ€ť â€“ are broad and thus may open the door for a rather inclusive approach to defining what types of technologies may qualify as â€śtelehealth.â€ť
- 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 patientâ€™s home.Â
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 â€“ so now is a good time to begin thinking through the options for providing input on HHSâ€™ approach to expanding use of telehealth services.