CMS telemedicine expansion could lead to cuts in Medicare base rate

With help from Darius Tahir and Mohana Ravindranath

TELEMEDICINE PROPOSAL WILL COST MONEY: A new CMS proposal to expand Medicare payments for virtual consultations foresees the telemedicine expansion as an additional expense that will be offset by cuts in the base rate paid to physicians.

The CMS physician fee schedule and quality payment proposal issued last Thursday calls for Medicare to pay doctors and nurses to conduct pre-visit check-ins with patients. On page 1104, the rulemakers estimate with this would eventually lead to an estimated 19 million check-in payments per year. The cost to Medicare would be offset with a 0.2 percent reduction in the “conversion factor,” or base rate paid to physicians, in order for the rule to meet legal requirements of budget neutrality for new payment codes.

The proposal, part of a 1,473-page quality and payment rule, would also pay clinicians to evaluate photos or videos the patients send in.

The rule won’t open the floodgates for telemedicine reimbursement by Medicare. It requires doctors to have a prior relationship with the patient, a limitation criticized by Krista Drobac, executive director of the Alliance for Connected Care. She noted that all states — and the AMA — allow relationships to be established via telemedicine.

“An established relationship with a provider will limit access for people who don’t have a usual source of care, or whose usual medical provider does not offer telemedicine,” Drobac said.

“They’re testing the waters,” Robert Jarrin, a senior director at Qualcomm, told POLITICO. (Jarrin also said, “On the one hand [they’re] being permissive with allowing these digital health services but much like R2-D4 in Star Wars, there’s a restraining bolt.” If you don’t understand this, ask the nearest Star Wars junkie)

The check-ins, while conceived as a way to prevent in-person care, would pay providers for a service they would otherwise often offer without charge, said Harvard researcher Ateev Mehrotra. Many patients already call a doctor’s office for a brief consult before booking an appointment.

A CMS official noted that such call-ins would have to be beneficiary-initiated, which sets a “high bar” that will limit how often the service is billed.

Tweet of the Day: Genevieve Morris @HITpolicywonk Please note if you try to reverse engineer VA email addresses, [email protected] is not me. There is a lovely lady in VBA receiving a lot of emails intended for me. I will be at my HHS account for a few more weeks.

Welcome to Monday Morning eHealth, where we spent much of the weekend reading Killers of the Flower Moon; the Osage Murders and the Birth of the FBI. It’s the kind of book that a non-fiction writer can read for pleasure while also marveling at its narrative artistry. Send fresh news and wisdom to [email protected], and don’t hide your light under a bushel on twitter @ravindranize, @arthurallen202, @dariustahir, @POLITICOPro, @Morning_eHealth.

JUST RELEASED: View the latest POLITICO/AARP poll to better understand Arizona voters over 50, a voting bloc poised to shape the midterm election outcome. Get up to speed on priority issues for Hispanic voters age 50+, who will help determine whether Arizona turns blue or stays red.

What role will Hispanic voters over 50 play in Arizona this Fall? Read POLITICO Magazine’s new series “The Deciders” which focuses on this powerful voting bloc that could be the determining factor in turning Arizona blue.

IS ONC STILL A THING?: We’ve been wondering about this because of the way CMS has moved aggressively into the interoperability issue, pushing personal health records, virtual care and even going so far as to consider making data sharing a Condition of Participation in Medicare. Plus, ONC always seems to be lending out its experts—the latest being principal deputy coordinator for health IT Genevieve Morris, on a one-year detail to get the Veterans Administration’s Cerner implementation off the ground. John Fleming, the deputy assistant secretary for health technology reform, is on his way out, having been nominated to assistant secretary of commerce for economic development.

… Spokesman Peter Ashkenaz says we’ve got it all wrong. True, CMS, as always, has the payment levers to make things happen in health IT, but ONC is still working on TEFCA, the data sharing rule, the definition of “Open APIs without special effort,” and an Aug. 6-8 interoperability forum. ONC contributed mightily to the proposed Evaluation and Management guidelines in last week’s CMS rule, Ashkenaz added. Plus, Jon White, who was on detail at CMS for three months, has returned to his job as deputy national coordinator.

…. Ashkenaz also provided us an update on progress with 2015 edition certification software, which CMS reiterated it will require providers to use in 2019. As of June, more than nine in 10 hospitals and four in five clinicians have 2015 edition-certified software, he said. A more fine-grained picture is available in this dashboard.

ONC ALSO DOING THIS: Its Health IT Advisory Committee announced Friday that Ken Kawamoto, associate chief medical informatics officer at the University of Utah School of Medicine, and Steven Lane, Sutter Health’s clinical informatics officer, will co-chair a 21-member Interoperability Standards Priorities Task Force, which meets Friday for the first time. After some jaw-flapping, the task force will publish a report recommending standards and implementation specifications that best support priority uses of health IT.

VA CHECKS OUT COLUMBUS PILOT: Several senior VA officials last Thursday visited the Columbus, Ohio VA hospital where a joint Leidos-Epic scheduling software pilot is underway, well-placed sources tell us. The VA did not respond to a request for comment on how the visit might bear on the agency’s eventual decision about whether to wind down the Epic project next April and install Cerner scheduling software throughout the VA as part of its transition to the commercial EHR vendor.

FDA WARNS OF FAKE WARNING LETTERS: The agency sayscriminals are sending them to people who order medicine online in an extortion scam. Instead of the drugs, they get the fake warning letters. More reason not to buy drugs online from unknown sellers, FDA says.

A FRESH START FOR INDIA’S HEALTH IT?: In February, the Indian government announced it would extend health insurance coverage to 500 million citizens, in effect creating the world’s largest insurance program. Now a group of India- and U.S.-based scholars have proposed a health IT backbone for the project that would avoid stumbling blocks that exist in the United States and elsewhere. “The greenfield nature of India’s digital health infrastructure presents an excellent opportunity to avoid the pitfalls of complex, restrictive digital health systems that have evolved elsewhere,” the scholars write. “We propose here a federated, patient-centric, application programming interface (API)–enabled health information ecosystem that leverages India’s near-universal mobile phone penetration, universal availability of unique ID systems, and evolving privacy and data protection laws.” The white paper here.

HOSPITALS THAT MOST OUGHT TO SHARE DON’T: A study by Julia Adler-Milstein of UC-San Francisco and Jordan Everson of Vanderbilt finds that while federal quality measures classify 97 percent of U.S. hospitals as routinely sending information electronically, only 63 percent send data to hospitals with whom the have the largest number of patients (in many cases, we suspect, their biggest competitors). The researchers used Medicare data to identify hospital pairs with the highest shared patient volume, then looked at how well they shared data. Among the 63 pairs they studied, 23 percent of respondents reported worse information sharing with their “paired” hospital than with other hospitals, while 17 percent indicated better sharing. The authors conclude that HHS should bear down on the data exchange requirements authorized by the 21st Century Cures Act. The full study for pros here.

WHAT WE’RE CLICKING:

—Reason: Nashville health department employees had access to health records of thousoands of AIDS patients

—Quartz: Why Alexa sucks as a doctor

—NPR: Researchers hope to use EHRs to develop drugs and other research

—Columbus Dispatch: Ohio “smart hospitals” use high tech to improve treatment