Telemedicine, opioid response tech get a boost in CMS payment proposal

With help from Arthur Allen (@arthurallen202) and Darius Tahir (@dariustahir)

TELEMEDICINE, OPIOID RESPONSE TECH GET A BOOST IN CMS PROPOSAL: CMS’ 1,473-page payment overhaul propose to pay clinicians for more virtual care, cut down on EHR-related documentation, and credit doctors who employ more tech to fight opioids. Health IT experts generally like the plan — or what they’ve read of it.

“If this pans out, could be awesome,” Bob Wachter tweeted. “There’s no more soul-sapping experience than documenting 9 Review of Systems elements & 10 body parts examined to justify a billing level – when what really took time was talking to patient, family, consultants, reviewing the chart, & thinking.”

The proposal is “a big step forward in advancing CMS policy to begin to better catch up with technology and meet consumers and clinicians where they are,” CHIME’s Mari Savickis tells Morning eHealth. Though her group is still querying members on its exact impact on technology, “from a clinical standpoint we support removing barriers and burdens whether electronic or paper which bog down clinicians and detract from patient care.”

Here’s a look at what’s inside the proposal, open for public comment ‘til mid-September:

—OPIOIDS: The agency proposes to tweak its Merit-based Incentive Payment System formula to give credit to opioid-related technology in two ways: First, by defining opioids measures as a “high priority,” since doctors who report high-priority metrics can get additional scoring in some circumstances. — and second, by incentivizing PDMP queries and the integration of PDMPs into electronic health records, Morning eHealth’s Darius Tahir reports.

—EHRS AND INTEROPERABILITY: A new “promoting interopability” category would replace the meaningful use parts of MIPS, and the agency would “change the category to reward providers that provide patients access to their health information,” administrator Seema Verma said in a call with reporters.

The rule would also streamline documentation requirements for Evaluation and Management office visits, which account for 20 percent of allowed charges under the Physician Fee Schedule, Morning eHealth’s Arthur Allen reports. Specifically, it would remove MIPS “process-based” quality measures that clinicians have said are low-value, and waive MIPS requirements in a Medicare Advantage pilot similar to an Advanced APM.

ONC, which has surrendered some of the interoperability portfolio to CMS, appears to be on board. The changes would lead to “significantly less documentation burden for clinicians treating Medicare beneficiaries,” ONC chief Don Rucker said in a news release. The rule could improve “workflows needed to support patient-centered care instead of a focus on meeting billing documentation requirements.”

—AND ESPECIALLY TELEMEDICINE: The proposal would allow clinicians to be paid for virtual check-ins and for evaluating photos or videos from patients. The agency historically had bundled “routine non-face-to-face communication” into payments for in-person visits, the rule says — but CMS is proposing to pay for video or audio check-ins even when they don’t lead to an office visit.

Verma said the rule will generally expand categories of care where telemedicine is covered. “For a lot of our beneficiaries it’s a challenge to get to a doctor,” Verma said in the call. “This is just another access point for communication with clinician. It doesn’t replace office visits.”

The rule’s telemedicine elements drew immediate enthusiastic responses. Krista Drobac, head of telemedicine trade group the Alliance for Connected Care, called the proposal the “biggest advancement in fee for service that we have seen.” Aisling McDonough, a health policy staffer for Sen. Brian Schatz, tweeted that she was “very excited about the telehealth stuff!!”

A new payment system could also allow physicians to be paid for consultations with patients with whom they don’t already have a prior relationship; CMS noted that it was seeking comment on whether a patient could share videos or photos of a skin condition with a dermatologist to figure out if they need an in-person visit, for instance.

VA NAMES ONC’S GENEVIEVE MORRIS TO LEAD EHR MODERNIZATION: The Veterans Affairs Department has named former ONC official Genevieve Morris to lead its new Office of Electronic Health Record Modernization, confirming news reported by POLITICO last week.

Morris said in a news release that her office, the Veterans Health Administration and VA’s Office of Information and Technology would “collaborate closely to ensure this important transition is as smooth as possible for our Veterans, clinicians and staff.“

She added: “We are working hard to configure and design a system focused on quality, safety and patient outcomes, which will allow health IT innovations within one VA facility to be used across the entire VA health-care system.”

Pros can read the rest of the story here.

REP. JIM BANKS TO LEAD HOUSE VETS’ NEW CERNER SUBCOMMITTEE: The House Veterans Affairs Committee is setting up a subcommittee to oversee the Cerner EHR implementation that Morris will be leading.

Rep. Jim Banks — a veteran with a background in real estate and state politics — will head up that five-member subcommittee, which includes ranking member Conor Lamb as well as Reps. Mike Coffman, Jack Bergman and Scott Peters.

Banks said after the hearing that Chairman Roe had asked him to take the job though he has no particular health care or IT chops, Arthur reports. Leading donors to his campaign in the current election cycle include defense and pharmaceutical industries. Leidos, lead contractor on MHS Genesis, contributed $5,000.

A spokesperson told Arthur that Banks “takes his new role seriously and will critically examine all aspects of the EHR’s implementation.” The lawmaker said in a news release he was “committed to asking the tough questions and challenging the bureaucratic status quo.”

Bergman, a retired Marine general, said his 40 years of service had exposed him to the “complexities associated with transferring information between VA and DoD, and even between branches of the military.”

MORE VA NEWS: As of July 11, VA’s Board of Veterans’ Appeals had issued more than 64,025 decisions for fiscal year 2018, compared to 36,079 for the same period last year. The previous high number of decisions in a single year was 55,532 in 2014, the agency says. In a news release, VA credited a new interactive decision template and a specialty case team. Speeding appeals was one of the major goals of the VA under Secretary David Shulkin before he was fired in March.

eHealth Tweet of the day: Eric Topol @EricTopol When “new” medical technology is 10 years old A1@washingtonpost by @Carolynyjohnson w/@rvmilani@OchsnerHealth patient perspective “what took you so long?”

It’s FRIDAY at Morning eHealth. Your author recently tried her first arepa (she’s embarrassingly late to the game) and hasn’t been able to think about anything else since. Direct her to your favorite Venezuelan food source and share news tips at [email protected]. Reach the rest of the team socially at @arthurallen202, @dariustahir,@ravindranize, @POLITICOPro,@Morning_eHealth.

WAYS AND MEANS FINISHES 11-BILL MARKUP: The House Ways and Means Committee finished off a marathon two-day markup Thursday, passing 11 bills dealing with tax-advantaged health savings accounts and tax provisions in the Affordable Care Act, POLITICO’s Bernie Becker reports.

One proposal, H.R. 6312 (115), to allow taxpayers to use health savings accounts to pay for gym memberships and other similar athletic pursuits sailed through 28-7 and attracted around a half-dozen Democrats. Fitbit Inc., the maker of the popular wearable fitness device, was among the companies that lobbied for the provision.

Proponents say that measure will help battle obesity in the U.S., but critics have said it will reward higher earners for recreational activities they would pursue anyway. Pros can read the rest of the story here.

HOUSE PASSES SLATE OF INTERNET BILLS: Five internet- and telecom-related bills are advancing to the full House floor, including one that directs the Commerce Secretary to launch a study on the connected devices industry, POLITICO’s Ashley Gold reports.

The House Energy and Commerce committee on Thursday also passed H.R. 2345 (115) which would require the FCC to study the feasibility of creating a dialing code specifically for suicide prevention or mental health crises. H.R. 3994 (115) would establish an Office of Internet Connectivity and Growth within the Commerce Department’s National Telecommunications and Information Administration. Pros can read about the rest of the bills here.

MORE ON FCC’s $100M TELEHEALTH PILOT IDEA: The FCC on Thursday outlined the information it wants from the public to shape a proposal for a $100 million fund subsidizing remote monitoring pilot programs for low-income American.

If approved at the FCC meeting in early August, the new notice of inquiry would seek detail on ways to create a “Universal Service Fund,” that would focus on low-income Americans transitioning out of health care facilities.

The notice, made public a day after commissioner Brendan Carr pitched the concept in an op-ed, also seeks detail on budget, application processes, and the broadband services that should be supported. It’s also looking for ways to measure the effectiveness of pilot programs.

Carr told Morning eHealth earlier this week the program could provide evidence supporting greater reimbursement for telemedicine.

WHAT WE’RE CLICKING ON:
—CNBC’s reports on a Facebookloophole letting third-parties find members of private groups — including one for women with a high risk of breast cancer — and one on Amazon’s partnership with Xealth to let doctors prescribe products

—A Star Tribune storyon Medtronic’s software upgrade alerts for implantable heart devices

—Quartz’s investigation into Alexa’s ability (or inability) to give health and wellness advice.